We are looking forward to helping your business determine the best types of health coverage, insurance and employee benefits that are right for your company and your group members. The following forms below will come in handy as we help guide you through the process.
Please download and complete the forms below as they pertain to the quotes you are seeking. Please fax or mail completed forms to Fax (704) 841-7903, or mail to Health Plan Purchasing Co. Inc., PO Box 2569, Matthews, NC 28106.
- Group Enrollment Checklist
- Agent of Record Letter
- Group Census Form
- Health Insurance for Small Business Form
- Risk Appraisal Form
Group Health Applications
- Employer Form
- Group Application
- Declination of Coverage
Group Life Applications
- Employer Application for Life Insurance (1-9)
- Employer Application for Life Insurance (10+)