| | RMHP Forms |
| | All forms and plan descriptions are in portable document format (PDF).
 |
| | Some forms are available for download in Spanish.
Click the language to download the form. |
| | Form Type: Medical |
| | Form Name | Form Description
|
| |
Application for Health Benefits For Groups with 2 or More Employees
English
() | Companies with two or more employees who work at least 24 hours a week must complete this form. |
| |
Disclosure Notice
English
(447 kb) | This form must accompany all rate quotes provided to employer groups. |
| |
Enrollment Form - Small Group Coverage
English
Spanish
(480 kb) | Each employee applying for coverage for themselves and dependents must complete this form. |
| |
Family Options Change Form
English
(427 kb) | Employers who change to a Family Options plan design can distribute this form to eligible employees for their dependents' plan design election. |
| |
Group Census Request
English
(412 kb) | Use the Group Census Form for new business that may not have a UITR. |
| |
Health Status Questionnaire
English
(429 kb) | Each employee applying for coverage for themselves and dependents must complete this form. |
| |
New Group Checklist
English
() | Checklist for new group enrollment |
| |
New Small Group Underwriting Guidelines
English
() | Learn about all the underwriting requirements for issuing a new small group health plan with RMHP |
| |
Request for Enrollment of Common Law Spouse
English
(411 kb) | Those eligible employees enrolling their common law spouse must complete this form. |
| |
RMHP- Change Form
English
Spanish
() | RMHP - Use this form to make changes to a group subscriber's coverage including name and address changes or adding or dropping dependent coverage. |
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