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Primary Health
These forms are PDF files. You will need a PDF viewer in order to use them.
Small Group Enrollment Application (2-50 employees)
Mid-Size Group Enrollment Application (51-99 employees)
Large Group Enrollment Application (100+ employees)
Authorization for the Use and Disclosure of Protected Health Information
Large Group Questionnaire (51+)
Quote Request Form
Employee Waiver of Coverage Form Agreement
Initial Preexisting Condition Exclusion (PCE) Notice
Short Term Brochure and Application
Smart Health Brochure
Smart Health Application
Short Term Essential Medical Insurance Brochure
Short Term Essential Application
