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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
New group plan — enrollment forms
ACH authorization form
Enrollment checklist
2020 Employer application — dental & vision
2020 Employer application — vision only
Employee application — dental & vision
Employee application — vision only
Census enrollment spreadsheet *New*
Existing Group Plan — additional forms
Change request form — dental vision
Employer guide — dental & vision
Employer guide — dental only
Employee termination form
VSP Out of Network reimbursement form
Individual forms
New individual — enrollment forms
Individual enrollment checklist
2020 Individual and family application — dental & vision
Existing individual — additional forms
ACH authorization form
Cancellation form
VSP Out of Network reimbursement form