FORMS
AvMed makes it easy to manage your account by providing forms and other tools for making requests. Simply print and fill out one of our pre-composed forms for quick, easy service. Certain requests can be submitted directly online.
SMALL GROUP FORMS
- 2020 Small Group Master Application
- Affidavit of Extended Dependent Eligibility
- Appointment of Representative (Group members)
- COBRA form
- Common Ownership Form
- Continuation of Coverage (mini-cobra)
- Contractor Relationship - 1099 Affidavit
- Employee Enrollment Form
- Employer Risk Questionnaire
- Employee Status Change Form
- Member Disclosure Form
- Member Transition of Service Form – Medical and Pharmacy
- PEO Questionnaire Form
- Small Group Case Submissions Checklist
- Small Group Submission Deadline Calendar
- Small Group Underwriting Guidelines (Effective 1/1/2020)
- Waiver of Coverage
LARGE GROUP FORMS
- Affidavit Extended Dependent Eligibility
- Appointment of Representative (Group members)
- COBRA form
- Employee Status Change Form
- Employee Enrollment Form
- Employer Risk Questionnaire
- Large Group Submissions Checklist
- Large Group Commission Rate Agreement Form
- Large Group Underwriting Guidelines
- Member Disclosure Form
- Member Transition of Service Form – Medical and Pharmacy
- Waiver of Coverage