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Broker forms

For big, small and everything in between, here are commonly-used forms and resources for individuals and groups.

Small group master application

We’re excited that after all the shopping around and research you’ve done, your group wants to partner up with us. Before we get started, we’ll need you to fill out this master application. Once it’s complete, send it over and we’ll take it from there.

DOWNLOAD APPLICATION ➜

Large group master application

Thanks for choosing us. We’re glad you’re ready to get your group covered with us. First, we’ll need some information about your company, employee eligibility, and your plan preferences. Then, we can start getting your group the care they need.

DOWNLOAD APPLICATION ➜

Sole proprietor, partner, or corporate officer statement

If the sole proprietor, partner, or corporate officer is not listed on the DE-6 tax form or the form isn’t available, they must fill out this short form and give us a few additional documents. 

DOWNLOAD FORM ➜

We're here to support you in any way we can. Contact us with your questions.

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Enrolling employees

When employees are ready to start getting coverage, they’ll need to fill out this form. This helps us organize and keep track of their benefits so that they can maximize their coverage and care.

DOWNLOAD ENGLISH APPLICATION ➜

Enrolling employees (Spanish)

Here's the employee enrollment form for our Spanish-speaking members.

DOWNLOAD SPANISH APPLICATION ➜

More individual member forms

Not finding what you're looking for? Check out the Member Center for more individual member forms such as pharmacy or medical reimbursement.

TAKE ME THERE ➜

Correction to group statement

Use this form to report adjustments to your monthly statements.

DOWNLOAD FORM ➜

Employer group size attestation

Use this form to attest to the size of your employer group. We'll need notification within 30 days of the change to the group size.

DOWNLOAD FORM ➜

Request for quote checklist

Have the employer fill out this sheet so that we can get a good idea of their needs.

DOWNLOAD CHECKLIST ➜

Declaration of domestic partnership

Even if a member and their partner are not legally married, they may still qualify for benefits. Have them fill out this form declaring their domestic partnership to see if they’re eligible. 

DOWNLOAD FORM ➜

Continuity of care benefits

This form can help a member continue care with a non-Sharp provider until treatment of their acute condition is over or until the end of her pregnancy.

MORE ABOUT CONTINUITY OF CARE ➜

Personal health information (PHI) release

Members can fill out this form if they would like their medical information shared with an organization, loved one, or representative.

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W-9

Here is a W-9 form you can download and fill out. 

DOWNLOAD FORM ➜