Iowa
Minnesota
Large Group Forms
Plans with a six-digit group number:
Enrollment/Change/Cancellation Form
Plans with a five-digit group number:
Group Enroll / Change / Cancellation Form (writeable PDF)
Group Enrollment / Change / Cancellation Form (Spanish)
Plan Selection Change Form
Plan Selection Change Form (Spanish)
Scheduled Direct Debit Authorization Form for Groups
Nebraska
North Dakota
Large Group Forms
Plans with a six-digit group number:
Enrollment/Change/Cancellation Form
Plans with a five-digit group number:
Group Enroll / Change / Cancellation Form (writeable PDF)
Group Enrollment / Change / Cancellation Form (Spanish)
Plan Selection Change Form
Plan Selection Change Form (Spanish)
Scheduled Direct Debit Authorization Form for Groups
South Dakota
Large Group Forms
Plans with a six-digit group number:
Enrollment/Change/Cancellation Form
Plans with a five-digit group number:
Group Enroll / Change / Cancellation Form (writeable PDF)
Group Enrollment / Change / Cancellation Form (Spanish)
Plan Selection Change Form
Plan Selection Change Form (Spanish)
Scheduled Direct Debit Authorization Form for Groups
Wisconsin
Large Group Forms
Plans with a six-digit group number:
Enrollment/Change/Cancellation Form
Plans with a five digit group number:
Group Enroll / Change / Cancellation Form (writeable PDF)
Group Enrollment / Change / Cancellation Form (Spanish)
Plan Selection Change Form
Plan Selection Change Form (Spanish)
Scheduled Direct Debit Authorization Form for Groups
Employer Service Center
For groups headquartered in Minnesota, North Dakota, South Dakota and Wisconsin:
1-800-936-6880
For groups headquartered in Iowa and Nebraska:
1-866-894-8052
Monday – Friday: 8 a.m. - 5 p.m. CT
Closed 8 a.m. - 9 a.m. Thursdays