Myriad Benefits, LLC. ~ Unique Solutions for Health Insurance

Online Benefits

Customer Hotline

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Group Forms

Individual Forms

Universal Small Group Application

Application for Enrollment (51-99)

Letter of Record – Employer Group

Employee Waiver of Coverage Agreement

Blue Shield Member Claim Form

Large Group Application for Enrollment (Experience-rated or ASC)

Request to add a Newborn to your Group or Individual Policy

Group Master Application

Idaho Group Proposal Form (2-50 and 51-99)

Select Cover Sheet & Individual Application

Summit Plan Information

NowSelect Plan Information

HSA Healthplan Information

Regence Now Select Individual Brochure

Policy Change Request Form

Automatic Payment Form

Blue Shield Member Claim Form

Medicare Supplement

Medicare Supplement Policy Change Request

HealthSense 65 Enrollment Form

Regence MedAdvantage Enrollment Form