Medical Benefit Change
- Signed Rates
- Admin and Benefit/Change Form – download below
- If the group will be offering more than one plan, a list of subscribers to be enrolled in each plan should be included with the benefits change.
Ancillary Adds
Dental/Vision
- Signed Rates
- Benefit Modification Form – download below
- Admin and Benefit Change Form – download below
- Enrollment Census – download below
Life and/or Disability
- Signed Rates
- Benefit Modification Form – download below
- Admin and Benefit Change Form – download below
- Enrollment Census – download below
- Hold Harmless – download below
Download the documents here:
MEWA Ancillary Add – Dental.Vis Forms
MEWA Ancillary Add – Life.Dis Forms
MEWA Medical Benefit Change Forms
