Resources, applications and forms

Resources

Individual Plan ACH Form (PDF)

Shop for Individual + Family Plans

Enroll online in an Individual + Family Plan

2024

2024 Individual + family plan book

Marketplace

2024 Marketplace plan options (PDF)

Direct

Plan options (PDF)
Application (PDF)

Online quote

Available exclusively for small businesses. Learn how Dean Delivers for employers of all sizes.

Small group options

2024

Small group plan book

Small group plan book (en Español) (PDF)

Small group plan options (PDF)

 

2023

Small group plan book

Small group plan book (en Español) (PDF)

Small group plan options (PDF)

Applications & forms

Employer group application (PDF)

Employer group application (En Español) (PDF)

Employee application (PDF)

Employee application (En Español) (PDF)

Submission checklist (PDF)

2013 (Pre-ACA Compliant)

Small group plan book (PDF)

Small group plan options (PDF)

Employer group application (PDF)

Employee application (PDF)

Innovative health plans

Choose a customized, fully-funded insurance plan or take advantage of cost savings through unique pre-built plans:

• View Smart Value Choice plan
• View Value Choice plan
• View Smart plans

Start a quote today.

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Large group options

2024

Large group plan options

Large group plan book

Large group plan book (en Español)

 

2023

Large group plan options

Large group plan book

Large group plan book (en Español)

Applications & forms

Employer group application

Employer group application (En Español)

Employee application

Employee application (En Español)

Large group checklist

2023

Plan guide & summary of benefits (PDF)

Application enrollment form (PDF)

2024

Enrollment guide (PDF)

Education guide (PDF)

Summary of Benefits (PDF)

Application enrollment form (PDF)

Additional resources

• Solicitation of disclosure (PDF)
• Waiver of coverage (PDF)
• Employee health history addendum (PDF)
• Group plan ACH form (PDF)
• Individual + Family Business and group agent social media graphics