Group Enrollment Forms
| One Platform Login | 2025 Enrollment Checklist |
| One Platform Resources | 2025 Small Group Master Application |
| Renewal Re-Rate Process | Group Size Attestation |
| Double and Triple Choice Options | Late Enrollment Acknowledgment Form |
| Premera Products Only Enrollment Census Template (One Platform)
Note: For Ancillary Products Contact Your Sales Exec for Personal Assistance: Amy Easley – Western Washington Emelie Hoffman – Eastern Washington |
2024 Small Group Master Application |
| Deductible Credit Process |
Member and Other Enrollment Forms
HSA Documents
| 2024 Personal Funding Account Setup Form | Funding Account ACH Authorization Form |
| PFA (Personal Funding Account enrollment application) | Funding Account Employer Admin Guide |