Forms & Downloads
Listed below are forms for conducting business with GHI.
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Related Links:
The GHI Health Savings Account Program |
- Broker Reference Guide
- Selling Agent Forms
- Small Group Forms
- Large Group Forms
- Mini-COBRA/ARRA Forms & Notices
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
Download the Broker Reference Guide
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.
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.
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.
List of commissions paid for community-rated GHI products.
Small Group Forms
Name/Description
Small Employer Group Application
Complete this application before enrolling a small employer group with GHI.
Complete this application before enrolling a small employer group with GHI.
Small Group Underwriting Guidelines
(8 pages)
Domestic Partner Eligibility Forms |
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Letter of Certification
This form is to be used when no tax documents are available.
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.
Use this form for enrolling, terminating or changing the status of a subscriber.
Small Business Advantage Plan (SBAP) Materials
SBAP Sales Sheet
(2 pages)
(2 pages)
Letter of Certification
This form is to be used when no tax documents are available.
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.
GHI's wellness programs available to all GHI members.
Large Group Forms
Name/Description
Large Employer Group Application
Complete this application before enrolling a large employer group with GHI.
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.
Use the form to enroll, terminate or change the status of a subscriber.
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