Forms - Inshore Benefits

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Find enrollment application forms for group and individual plans, plus payment authorization forms, employer guides and broker toolkit items!

Group forms

Enrollment Forms

California

Census enrollment — CA
2023 Employer application — dental & vision
Employee application — dental & vision

Colorado

Census enrollment — CO
2023 Employer application — dental & vision
Employee application — dental & vision

Texas

Census enrollment — TX
2023 Employer application — vision only
Employee application — vision only

All States (not available in FL)

2023 Employer application — vision only
Employee application — vision only

Additional Forms
ACH authorization form
Enrollment checklist
Employer guide — dental & vision
Employee termination form

Group & Member Notices
Annual VSP Member Notification — California

Identity & Device Protection — NortonLifeLock Applications
Employer application
Employee application
Census enrollment — Norton

Individual forms

New Individual — Enrollment Forms
Individual enrollment checklist
2023 Individual and Family application — dental & vision
ACH authorization form

Additional Forms
Cancellation form