Employer Forms
Employer Forms
Complete each form email the completed form to Karen.
Complete Core Documents
Click on the title above to access the Core Documents.
ACH Payment Authorization
Click on the title above to access the form. Once completed FAX the form to: (260) 444-4212
Monthly Defined Contribution Agreement
Click on the title above to access the form. Once completed email the completed form to Karen.
ICHRA Contribution Agreement
Click on the title above to access the form. Once completed email the completed form to Karen.
Employee Change Form
Click on the title above to access the form. Once completed email the completed form to Karen.
Employee Agreement Form
Click on the title above to access the form. Once completed email the completed form to Karen.
New Group Form
Click on the title above to access the form. Once completed email the completed form to Karen.
Employee Consent & Agreement Form
Click on the title above to access the form. Once completed email the completed form to Karen.
3711 Rupp Dr., Suite 103,
Fort Wayne, IN 46815
Office: (260) 755-3585
Toll-Free: (866) 764-2204
Fax: (260) 444-4212
Proud to be a veteran-owned business.