Iowa
Minnesota
Large Group Forms
Plans with a six-digit group number:
Plans with a five-digit group number:
Small Group Forms
Nebraska
North Dakota
Large Group Forms
Plans with a six-digit group number:
Plans with a five-digit group number:
Small Group Forms
South Dakota
Large Group Forms
Plans with a six-digit group number:
Plans with a five-digit group number:
Wisconsin
Large Group Forms
Plans with a six-digit group number:
Plans with a five-digit group number:
Small Group Forms
- Small Employer Group Application (PDF)
- Group Enroll/Change/Cancellation Form (writeable PDF)
- Plan Selection Change Form (PDF)
- Plan Selection Change Form (Spanish) (PDF)
- Scheduled Direct Debit Authorization Form for Groups (PDF)
- Small Group Enrollment/Change/Cancellation Form (Spanish) (PDF)
- Wisconsin Small Group Uniform Application (PDF)
Employer Service Center
For groups headquartered in Minnesota, North Dakota, South Dakota and Wisconsin:
1-800-936-6880
For groups headquartered in Iowa and Nebraska:
1-866-894-8052
Monday – Friday: 8 a.m. - 5 p.m. CT
Closed 8 a.m. - 9 a.m. Thursdays