This page brings together the main enrollment and renewal administration resources for Business Health Trust groups, including 2026 enrollment forms, renewal bulletins, administrative guides, new and renewal group checklists, and deductible credit instructions.
Renewal Bulletins
Use this guide to review 2027 plan changes, Premera and Kaiser options, Nice Healthcare benefits, ancillary products, network details, and steps for quoting and enrollment through AP Connect.
Processes
Use these resources to prepare new group or renewal submissions, track required items, and handle deductible credit transfers from a prior carrier.
Instructions
New and renewal group submissions
Underwriting Guidelines
Kaiser Small Group: Quarterly wage reports
- Wage Report Instructions (PDF)
- Quarterly Wage Detail Report — Form 5208B (PDF)
- Redacted Wage Report Example (PDF)
- Download All Wage Report Documents (ZIP)
Deductible credits
Section 125 Premium Only Plan (POP)
Enrollment
Use these forms and census templates to collect employee information, enrollment details, waivers, coverage changes, and renewal data before submission.
Enrollment Forms & Template
- Enrollment Census Template (Excel, Updated 10/26/2026)
- Proposal / Quote Census Template (Excel, updated 10/26/2026)
Kaiser Permanente AHP — Medical
Enrollment and change forms (Word):
- Aerospace
- Agriculture
- Business Services
- Community Service Organization
- Healthcare
- Information Technology
- Media
- Retail
- Tourism
- Transportation
- Wholesaling
Premera AHP — Medical
Enrollment and change forms (Word):
- Aerospace
- Agriculture
- Business Services
- Community Service Organization
- Construction
- End-Line Manufacturing
- Healthcare
- Information Technology
- Media
- Retail
- Tourism
- Transportation
- Wholesaling
Kaiser Permanente Small Group Medical / BHT Non-Medical
- [use for both SG & Non-Med enrollment] Small Group Enrollment and Change Form (Fillable PDF)
Group Administrative Guides
Use these guides for post-enrollment administration, including eligibility, enrollment rules, terminations, COBRA, leaves, SIMON, billing, and common issues.
Download Guides
BHT Programs
BHT Industry Health Trusts
Additional Forms
Use these carrier and administrative forms for medical, dental, life, vision, COBRA, EFT, SIMON access, reimbursement, and other coverage-related updates.
Carrier Forms
Premera Blue Cross
Enrollment, member and pharmacy forms
- Deductible Credit Form
- Disabled Dependent Certification
- Domestic Partner Affidavit
- Home Delivery Order Form
- Incident Questionnaire
- Information Release Form
- Medical Claim Form
- Member Appeal and Authorization Form
- Other Coverage Questionnaire
- Prescription Drug Claim Form
- Prescription Prior Authorization and Exception Request
- Waiver of Coverage Form
Provider forms
- Corrected Claim Cover Sheet
- Massage Therapy Prescription Form (Word)
- Massage Therapy Prescription Tip Sheet
- Overpayment Notification Form
- Provider Appeal Form – Commercial Plans
- Real-Time Claims Request (Word)
- Refund Letter for Amounts Under $50
- Supporting Document Cover Sheet
Kaiser Permanente
- Coverage Declination Attestation – Small Group
- Coverage Waiver – IHT (English)
- Coverage Waiver – IHT (Spanish)
- Deductible and Out-of-Pocket Credit – IHT
- Deductible and Out-of-Pocket Credit – Small Group
- Domestic Partner Affidavit
- Medical Claim Reimbursement Form
- Prescription Drug Claim Form
Delta Dental
- Coordination of Benefits Questionnaire
- Custodial Parent Application
- Dental Claim Form
- Disabled Dependent Application
- Domestic Partner Affidavit
- Domestic Partner Directive
- HIPAA Authorization Form
- Out-of-Country Claim Form
VSP
USAble Life
- Beneficiary Designation Form
- Evidence of Insurability
- Life Claim Form
- Life Conversion Form
- Voluntary Life Application
