Forms & Downloads

 

Listed below are forms for conducting business with GHI.

Related Links:
The GHI Health Savings Account Program
HSA Agent/Broker Sales Kit
  
  

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
Format/Size
  
  
  
Selling Agent Forms

Name/Description
Format/Size
  
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.
PDF/62KB
  
Selling Agent Agreement
Must be completed and accompanied by the Selling Agent Agreement (above). Please mail the completed form to your GHI General Agent.
PDF/47KB
  
Selling Agents Commissions Schedule
List of commissions paid for community-rated GHI products.
PDF/17KB
  
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Small Group Forms

Name/Description
Format/Size
  
Small Employer Group Application
Complete this application before enrolling a small employer group with GHI.
PDF/15KB
  
Domestic Partner Eligibility Forms
Declaration of Financial Interdepedence (2 pages)
Alternative Affidavit of Domestic Partnership (1 pages)
PDF/34KB
  
PDF/123KB

Letter of Certification
This form is to be used when no tax documents are available.
PDF/37KB
  
Transaction form for Group Accounts
Use this form for enrolling, terminating or changing the status of a subscriber.
PDF/38KB
  

Community Rated PPO Plan Materials

PPO Sales Sheet
(2 pages)
PDF/75KB
  
PDF/80KB
  
Rx Sales Sheet
(2 pages)
PDF/103KB
  
PDF/613KB
  

Community Rated EPO Plan Materials

EPO Sales Sheet
(2 pages)
PDF/73KB
  
PDF/74KB
  
Rx Sales Sheet
(2 pages)
PDF/81KB
  
PDF/723KB
  

Small Business Advantage Plan (SBAP) Materials

SBAP Sales Sheet
(2 pages)
PDF/169KB
  
PDF/59KB
  
Preferred Plus Dental Plan Description
2 Tier and 4 Tier
PDF/46KB
  
Letter of Certification
This form is to be used when no tax documents are available.
PDF/37KB
  
Good Health Incentives Highlights
GHI's wellness programs available to all GHI members.
  
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Large Group Forms

Name/Description
Format/Size
  
Large Employer Group Application
Complete this application before enrolling a large employer group with GHI.
PDF/103KB
  
Transaction Form for Group Accounts
Use the form to enroll, terminate or change the status of a subscriber.
PDF/76KB
  

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