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Forms All employers Change Form (HP 401026) Claim Form (HP 401027) Combined Medical/Dental Enrollment Form - with no waiting 490033 Combined Medical/Dental Enrollment Form - with waiting 490034 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) Medicare Secondary Payer 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