Applications
BusinessEDGE®
- BusinessEDGE® Employee Enrollment Application (Height and Weight must be included for both underwriting and applying for coverage)
- BusinessEDGE® Solicitud de inscripción del empleado, rechazo y coordinación de beneficios (Español)
Enrollment Applications Small Group 1-50
Only use these files for 1-50 plans (new hires, renewals)
Enrollment Applications Mid Market 51-150 Eligible
Employer Group Enrollment Applications (Small Group and Mid Market)
- 2023 Employer Group Application
- Virginia Group Health Insurance Medical History Form
- Optima Equity Health Savings Account (HSA) Enrollment Form
- Employer Group Health Questionnaire
- Enrollment Spreadsheet
- 1099 Eligibility and Attestation Form