Forms Finder

Select the size of your group and the carrier you want to work with. Then specify whether it’s new or existing business, then select the product type. You can also search for additional miscellaneous carrier enrollment tools. Please contact sales@dickerson-group.com if you are having trouble finding your desired form.

Click Here for Additional Carrier Sales Materials

Complete Carrier 2020 Enrollment Kits

See below for complete enrollment kits for each carrier. Please note that the date in parenthesis indicates the effective date of the form.

All forms, even if a few months old, are the most up-to-date.

(Click here for complete 2019 Enrollment Kits)

Aetna Complete Enrollment Kit

Aetna CA New Business Checklist (5-1-19)

Aetna Employer App (4-1-19)

Aetna Employee Enrollment / Change Form (4-1-19)

Aetna CA Banking Consent (11-1-19)

Aetna Proof of Eligibility Form (3-5-14)

Aetna FTE Certification (2-1-16)

Anthem Complete Enrollment Kit

Anthem Enrollment Checklist (8-1-19)

Anthem Combined Med and Specialty Employer App (1-1-20)

Anthem Combined Med and Specialty CA Employee App (1-1-20)

Anthem Electronic/Recurring Payment Option (5-1-16)

Anthem Specialty and Med Employee Waiver Form (1-1-20)

Anthem Eligibility Statement (1-1-19)

Blue Shield Complete Enrollment Kit

Blue Shield Enrollment Checklist (1-1-20)

Blue Shield Employer Application (1-1-20)

Blue Shield Employee Application (1-1-20)

Blue Shield Initial Payment Form (6-1-18)

Blue Shield Refusal of Coverage (1-1-20)

Blue Shield Owner Eligibility Statement (10-1-19)

Blue Shield Start-Up / Spin-off Group Eligibility Statement (10-1-19)

Blue Shield Sole Proprietor, Partner, or Corp. Officer Statement (5-1-18)

California Choice Complete Enrollment Kit

California Choice Checklist (1-1-18)

California Choice Employer App (1-1-20)

California Choice Employee Enrollment App (1-1-20)

California Choice ACH Payment Form (4-1-18)

California Choice Owner/Partner Statement (1-1-16)

California Choice Case Submission Acknowledgement (1-1-20)

Choice Builder Complete Enrollment Kit

Choice Builder Checklist (10-1-16)

Choice Builder Employer App (1-1-20)

Choice Builder Employee App (1-1-20)

Choice Builder Employer One Time Payment (10-1-18)

Choice Builder Change Request Form (1-1-20)

Choice Builder Benefit Summaries Quote (1-1-20)

Choice Builder Program Highlights (1-1-20)

Covered California Complete Enrollment Kit

Covered California New Business Checklist (1-1-20)

Covered California Employer App (1-1-20)

Covered California Employee App (10-8-19)

Covered California Employee Waiver (10-8-19)

Covered California Late Submission Acknowledgment (3-1-18)

Health Net Complete Enrollment Kit

Health Net Checklist (3-1-19)

Health Net Employer App (1-1-20)

Health Net Employee App (1-1-20)

Health Net Electronic Check Form (5-1-19)

Health Net Proof of Eligibility (4-1-19)

Health Net Reasons for Employee Enrollment Delays (5-1-18)

Kaiser Complete Enrollment Kit

Kaiser Checklist (1-1-20)

Kaiser Employer App (1-1-20)

Kaiser Employee App (1-1-20)

Kaiser Employee App Spanish (1-1-20)

Kaiser Owner/Office Eligibility Statement (1-1-20)

Kaiser New Employee Eligibility (1-1-20)

Kaiser Electronic Transfer (1-1-20)

Kaiser Declination of Coverage (1-1-20)

Kaiser Declination of Coverage Spanish (1-1-20)

Kaiser Employer Attestation Declination of Coverage (1-1-20)

Kaiser Payroll Attestation (1-1-20)

Oscar Complete Enrollment Kit

Oscar Eligibility Checklist (1-1-20)

Oscar Employer Application (1-1-20)

Oscar Employee App (1-1-20)

Oscar ACH Authorization Form (1-1-20)

Oscar Employee Waiver Form (1-1-20)

Oscar Corporate Officer Proprietor or Partnership Form (1-1-20)

United Healthcare Complete Enrollment Kit

United Healthcare Checklist (11-3-17)

United Healthcare Employer Application (8-1-19)

United Healthcare Employee Enrollment (10-1-19)

United Healthcare Direct Debit (1-1-20)

United Healthcare Detailed Benefit Grids (1-1-20)

United Healthcare Product Selection Form (1-1-20)

Benefit Summaries

• Aetna

• Anthem Blue Cross

• Blue Shield

• CaliforniaChoice ®

• Choice Builder®

• Health Net

• Kaiser Permanente

• Oscar Health

• SIMNSA

Summary of Benefits and Coverage (SBC)

• Aetna

• Anthem Blue Cross

• Blue Shield

• CaliforniaChoice ®

• Health Net

• Kaiser Permanente

• MediExcel

• Oscar Health

Covered California for Small Business

• Blue Shield

• CCHP Health Plan

• Health Net

• Kaiser Permanente

• Sharp

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