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Inside Home
For your convenience, we are including the most frequently used forms for our administrators and carriers. All forms are in a PDF file format and can be viewed in Adobe® Reader®. Adobe Reader is free software for viewing and printing Adobe Portable Document Format (PDF) files on major hardware and operating system platforms.
Hollister Benefits Company, Inc.
 | HBC Census Report: Download and complete for a group health insurance quote. We will shop the market for you with all of our carriers in order to quote the best rates available for the level of coverage that best suits the needs of your company. Fax back to us at 410-860-6820. |
| HIPAA Checklist: A checklist to ensure that you are meeting the requirements for HIPAA privacy compliance. This checklist is not intended for legal use. Contact your attorney for further clarification. |
For Clients Of Kelly & Associates Insurance Group, Inc.
| Administrative Guidelines & Procedures: This is a brief outline explaining KAIG's billing procedures, subscriber enrollment guidelines, and COBRA/State continuation. |
| Employee Election Form: Form required for employee enrollments and waiver of coverage. |
| Employee Termination/Change Forms: Form required for employee termination and changes including address change, PCP change, coverage change, etc. |
| COBRA, Maryland State Continuation and HIPAA Information Packet: KAIG has compiled an information packet with the recommendation that you have your attorney review and revise the forms to meet the specific needs of your company. |
| COBRA Continuation Election Form: This is a sample form that can be personalized for your company for COBRA continuation. |
| Maryland Continuation Election Form: This is a sample form that can be personalized for your company for Maryland continuation. |
The Guardian
| Employer Questionaire-Destiny Health: This questionnaire is used by Guardian to evaluate groups as part of the proposal process. This form is not an application for insurance. Under no circumstances should you cancel your present group insurance coverage without written notice of approval and acceptance from Guardian Life Insurance Co. of America. |
Integra Administrative Group
| New Case Information Checklist |