Forms

Anthem

• Blue Access brochure
• Blue Access Economy brochure
• Blue Access Value brochure
• Small Group (employee enrollment) 2-50 employees (pdf 107kb)
• Change Form (employee changes) (pdf 99kb)
• Individual Application (not group) (pdf 188kb)
• Term Form (termination of employee) (pdf 98kb)
• Small Group (employer application/changes) 2-50 employees (pdf 52kb)

Delta Care Plus

• KY Group Application (pdf 131kb)
• KY Individual Application (pdf 112kb)
• Verification of Eligibilty (pdf 39kb)

Delta Dental

• KY Application (pdf 18kb)
• Plan Change Form (pdf 216kb)
• KY 2-49 Plan Rates (pdf 221kb)

Humana

Use Humana's agent portal to access all forms

MetLife

• STD Employee Statement (pdf 1.7mb)
• STD Employer Statement (pdf 1.4mb)
• STD Attending Physicain Statement (pdf 1.1mb)

One America

• STD Claim Form (pdf 674kb)

Reliance Standard

• Beneficiary Form (pdf 339kb)
• Plan Change Request (pdf 159kb)
• Portability Form (pdf 109kb)
• STD Claim Form (pdf 265kb)

Spectra

Kentucky

• KY Enrollment Form (pdf 32kb)
• Vision Care Information (pdf 111kb)

 

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