The reality of today's workplace is that employees are often changing jobs or changing status that affects their benefits coverage. To assist you in the important work of benefits administration, Advantage Benefits Group has assembled the commonly used forms that our clients need to manage their health and disability insurance plans.

Click on each link for a downloadable or printable copy of the relevant form. Group Medical & Dental Administration & Enrollment

• Massachusetts Health Insurance Responsibility Disclosure (HIRD)
• Delta Dental Enrollment
• Blue Cross Blue Shield
  • Enrollment Form
  • Affidavit of Domestic Partnership
  • Student Certification Affidavit
  • Fitness Benefit Form
  • Waiver Form
• Harvard Pilgrim Health Care
  • Prescription Mail Service Order Form
  • HMO Enrollment Form
  • PPO Enrollment Form
  • Waiver Form
• Fallon Community Health Plan
  • Select & Direct Enrollment Form
  • Mini-COBRA Premium Subsidy Attestation and Verification Form
  • Prescription Mail Service Order Form
• Tufts
  • Dependent Certification Form
  • Enrollment Form
  • Fitness Club Reimbursement Form
  • Member Change Form
  • Prescription Mail Service Order Form
  • Waiver Form

Group Life & Disability Administration & Claim Forms

Fort Dearborn Life (FDL) Enrollment	FDL Life/Death Claim
FDL Evidence of Insurability	FDL Short Term Disability Claim
Tufts Transmittal	Group Waiver Form

Click here for our clients’ Top 10 Reasons to Partner with Advantage Benefits Group