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Choose the state where your company's headquarters is located to find and print administrative forms.

Iowa

Large group forms

Enrollment/Change/Cancellation (PDF)

Enrollment/Change/Cancellation - Spanish (PDF)

Small group forms

Small Employer Group Application (PDF)

Enrollment/Change/Cancellation (PDF)

Enrollment/Change/Cancellation - Spanish (PDF)

Minnesota

Large group forms

Plans with a six-digit group number:

Enrollment/Change/Termination (PDF)

Plans with a five-digit group number:

Group Enrollment/Change/Cancellation (writeable PDF)

Group Enrollment/Change/Cancellation (Spanish) — (writeable PDF)

Plan Selection Change (PDF)

Scheduled Direct Debit Authorization for Groups (PDF)

Small group forms

Small Employer Group Application (writeable PDF)

Group Enroll/Change/Cancellation (writeable PDF)

Plan Selection Change (PDF)

Scheduled Direct Debit Authorization for Groups (PDF)

Small Group Enrollment/Change/Cancellation (Spanish) — (PDF)

Tips for employers

Group Enrollment/Change/Cancellation Form: Tips for Employers (PDF)

Medica Plan Selection Form: Tips for Employers (PDF)

Nebraska

Large group forms

Enrollment/Change/Cancellation (PDF)

Enrollment/Change/Cancellation - Spanish (PDF)

Small group forms

Small Employer Group Application (PDF)

Enrollment/Change/Cancellation (PDF)

Enrollment/Change/Cancellation - Spanish (PDF)

North Dakota

Large group forms

Plans with a six-digit group number:

Enrollment/Change/Termination (PDF)

Plans with a five-digit group number:

Group Enrollment/Change/Cancellation (writeable PDF)

Group Enrollment/Change/Cancellation - Spanish (writeable PDF)

Plan Selection Change (PDF)

Scheduled Direct Debit Authorization for Groups (PDF)

Small group forms

Small Employer Group Application (writeable PDF)

Group Enroll/Change/Cancellation (writeable PDF)

Plan Selection Change (PDF)

Scheduled Direct Debit Authorization for Groups (PDF)

Small Group Enrollment/Change/Cancellation (Spanish) — (PDF)

Tips for employers

Group Enrollment/Change/Cancellation Form: Tips for Employers (PDF)

Medica Plan Selection Form: Tips for Employers (PDF)

South Dakota

Large group forms

Plans with a six-digit group number:

Enrollment/Change/Termination (PDF)

Plans with a five-digit group number:

Group Enrollment/Change/Cancellation (writeable PDF)

Group Enrollment/Change/Cancellation (Spanish) — (writeable PDF)

Plan Selection Change (PDF)

Scheduled Direct Debit Authorization for Groups (PDF)

Small group form

Small Employer Group Application (writeable PDF)

Group Enroll/Change/Cancellation (writeable PDF)

Plan Selection Change (PDF)

Scheduled Direct Debit Authorization for Groups (PDF)

Small Group Enrollment/Change/Cancellation (Spanish) — (PDF)

Tips for employers

Group Enrollment/Change/Cancellation Form: Tips for Employers (PDF)

Medica Plan Selection Form: Tips for Employers (PDF)

Wisconsin

Large group forms

Plans with a six-digit group number:

Enrollment/Change/Termination (PDF)

Plans with a five-digit group number:

Group Enrollment/Change/Cancellation (writeable PDF)

Group Enrollment/Change/Cancellation (Spanish) — (writeable PDF)

Plan Selection Change (PDF)

Scheduled Direct Debit Authorization for Groups (PDF)

Small group forms

Small Employer Group Application (writeable PDF)

Group Enroll/Change/Cancellation (writeable PDF)

Plan Selection Change (PDF)

Scheduled Direct Debit Authorization for Groups (PDF)

Small Group Enrollment/Change/Cancellation (Spanish) — (PDF)

Tips for employers

Group Enrollment/Change/Cancellation Form: Tips for Employers (PDF)

Medica Plan Selection Form: Tips for Employers (PDF)