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Forms & Benefits

Please use the links below for any documents required to enroll in or change benefits related to the CBX Program. To view the CBX Benefits Booklet, please contact your benefits consultant.  New Groups need to complete the Participation Agreement and all eligible employees will fill out either the application or declination.  Existing Groups will need the change and termination forms.  Finally, Claim Forms and all of the EOCs are at the end.

Enrollment Information & Forms

Employer Application for all size firms – one application regardless of the number of plans you choose

Employer Application foAll enrolling employees must complete this form

Use for obtaining a quote from Q&A Insurance Marketing

Employees waiving group coverage must complete the Declination section

For employees enrolling in voluntary term life

For employees enrolling in voluntary term life

Used when applying for amounts in excess of non-medical maximum or outside of the initial offering

New Groups

Forms for Existing Groups

Use when your firm needs to cancel benefits due to termination or resignation

Use to make changes to existing employee information

Use to make change to your firm’s group offering during open enrollment

All enrolling employees must complete this form

Employees waiving group coverage must complete the Declination section

Existing Groups
Claims

Claim Forms

EOC's

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