Forms & Downloads

 

Listed below are forms for conducting business with GHI.

Related Links:
The GHI Health Savings Account Program
  
  

NOTE: The forms on this page are available as Adobe® PDF files. You will need Adobe Reader®, a free program from Adobe, to download and print the forms. Click here to get Adobe Reader now. Follow Adobe's instructions for download and installation. Print out the appropriate form and mail it to the address listed on the form.

  
Broker Reference Guide

Name/Description
  
  
  
Selling Agent Forms

Name/Description
  
Selling Agent Appointment Application
Authorizes you to sell GHI products for commission. Must accompany the Selling Agent Appointment Application (below). Please mail the completed form to your GHI General Agent.
  
Selling Agent Agreement
Must be completed and accompanied by the Selling Agent Agreement (above). Please mail the completed form to your GHI General Agent.
  
Selling Agents Commissions Schedule
List of commissions paid for community-rated GHI products.
  
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Small Group Forms

Name/Description
  
Small Employer Group Application
Complete this application before enrolling a small employer group with GHI.
  
Domestic Partner Eligibility Forms
Declaration of Financial Interdepedence (2 pages)
Alternative Affidavit of Domestic Partnership (1 pages)
  

Letter of Certification
This form is to be used when no tax documents are available.
  
Transaction form for Group Accounts
Use this form for enrolling, terminating or changing the status of a subscriber.
  

Small Business Advantage Plan (SBAP) Materials

SBAP Sales Sheet
(2 pages)
  
Preferred Plus Dental Plan Description
2 Tier and 4 Tier
  
Letter of Certification
This form is to be used when no tax documents are available.
  
Good Health Incentives Highlights
GHI's wellness programs available to all GHI members.
  
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Large Group Forms

Name/Description
  
Large Employer Group Application
Complete this application before enrolling a large employer group with GHI.
  
Transaction Form for Group Accounts
Use the form to enroll, terminate or change the status of a subscriber.
  

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