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Forms
Forms
All employers
Change Form (HP 401026)
Claim Form (HP 401027)
Medical Coordination of Benefits Form (HP 401028)
Dental Enrollment Form - Choice Plans (DT701001)
Dental Enrollment Form - Exceed Plans (DT 790002)
Dental Coordination of Benefits Form (DT 701007)
Dental Enrollment Form - Open Access (DT790003)
Dental Enrollment Form - Voluntary (DT790004)
Employers with
51+ employees
Medical Enrollment Form -- Primary Clinic Plans (HP 401025)
Medical Enrollment Form -- Open Access and National Plans (HP 490018)
National plans enrollment form (HP401031)
National plans change form (HP401032)
Employers with 2 – 50 employees
MN Small Group Employer Application 401012
MN Small Group Employee Application 401029
Small Group Domestic Partnership Coverage Policy
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