Forms & Downloads
Listed below are forms for conducting business with GHI.
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Related Links:
The GHI Health Savings Account Program HSA Agent/Broker Sales Kit |
- Broker Reference Guide
- Selling Agent Forms
- Small Group Forms
- Large Group Forms
- Dental
- 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
Format/Size
Download the Broker Reference Guide
PDF/3MB
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.
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.
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.
List of commissions paid for community-rated GHI products.
PDF/17KB
Small Group Forms
Name/Description
Format/Size
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.
PDF/15KB
Small Group Underwriting Guidelines
(8 pages)
PDF/722KB
Domestic Partner Eligibility Forms |
PDF/34KB
PDF/123KB
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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.
PDF/38KB
Community Rated PPO Plan Materials
Community Rated EPO Plan Materials
Small Business Advantage Plan (SBAP) Materials
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
Format/Size
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.
PDF/103KB
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.
PDF/76KB
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