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Small Group Forms MN Small Group Employee Application 401029 MN Small Group Employer Application 401012 Change Form (HP 401026) Claim Form (HP 401027) Medical Coordination of Benefits Form (HP 401028) Seasonal Employee Agreement Pregnancy Amendment Ownership and Hours Affidavit Controlled Group Form Combined Medical/Dental Enrollment Form - with waiting 490034 Combined Medical/Dental Enrollment Form - with no waiting 490033 Dental Enrollment Form - Choice Plans (DT701001) Dental Enrollment Form - Exceed Plans (DT 790002) Dental Enrollment Form - Open Access (DT790003) Dental Enrollment Form - Voluntary (DT790004) Dental Coordination of Benefits Form (DT 701007) WI Small Employer Group Application 490022 Small Group Domestic Partnership Coverage Policy WI Verification of Termed Employees MN Verification of Termed Employees Small Group Cancellation Request Form