CPM Group Insurance Services, Inc.

CPM Group
Insurance Services, Inc.

Group Insurance, Workplace Solutions, Financial Services


Benefit Forms:

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Please feel free to access and download any forms you need. We will continue to update and add to our forms section to better serve our clients, saving them time while providing convenience. If there is a particular form you frequently need that you would like to see posted here, contact us and we'll try to provide it here for you. Of course if you need any form not found here, call our office and we'll get it to you ASAP.

Benefit Forms

Click your Carrier's Name
to jump directly to their forms:

Benefit Forms
Sample only. Click specific forms to download and print the document you need.

Click here to connect directly to Aetna Aetna
Click logo to connect
directly to Aetna.

Enrollment Change-Term Form 
Family Health Statement  
Prescription Claim Form 
Prescription Home Delivery 
Waiver of Coverage

Aetna
Member Services (888) 287-4295
Mail Enrollment Material to:
1 Far View
Cranbury, NJ  08512
Or Fax to (866) 682-3862
www.Aetna.com


Click here to connect directly to Anthem Anthem
Click logo to connect
directly to Anthem.

Enrollment and Membership Change Form 
Family Health Statement 
Mail Order Prescription Form 
Medical Claim Form 
Report of Terminations

Anthem
Member Services (800) 843-6096
Mail Enrollment Material to:
370 Bassett Road
North Haven, CT  06473
Or Fax to: (203) 985-6331                www.Anthem.com

 


Click here to connect directly to CBIA  CBIA
Click logo to connect
directly to CBIA.

Health Connections
Enrollment Change-Term Form 
Family Health Statement  
Waiver Form

Health Connections 2
Enrollment Change-Term Form
Family Health Statement
Waiver Form

CBIA Health Connections
Mail Enrollment Material for all carriers to:
350 Church Street
Hartford, CT  06103-1126
Or Fax to (860) 278-0883  
www.CBIA.com

 


Click here to connect directly to Connecticare ConnectiCare
Click logo to connect
directly to Connecticare.

Enrollment Change-Term Form 
Family Health Statement 
Student Verification  
Mail Order Prescription Form 
Prescription Claim 
Waiver Form  

ConnectiCare
Member Services (800) 251-7722
www.Connecticare.com

 


Click here to connect directly to Guardian  Guardian
Click logo to connect
directly to Guardian.

Enrollment Change Form 
Dental Claim Form
 
Medical Claim Form 

Guardian
Member Services (888) 278-4542
www.Guardianlife.com 


 Guardian/Health Net

Enrollment-Change-Term Form  
Election of COBRA Continued Coverage

Guardian/Health Net
Member Services (888) 278-4542
Enrollment Material:
Must contact Carrier to access Fax#
Varies depending on group #
www.Guardianlife.com

 


Click here to go directly to Health Net  Health Net
Click logo to connect
directly to Health Net.

Change Form  
Charter HMO Enrollment Form 
Charter POS Enrollment Form 
Express Scripts 
Medical Claim Form 
Prescription Claim Form 

Health Net
Member Services (800) 441-5741
www.HealthNet.com

 


Click here to go directly to Oxford  Oxford
Click logo to connect
directly to Oxford.

Enrollment-Termination-Change Form 
Family Health Statement 
Health Benefits Waiver of Coverage Form  

Oxford Health Plans
Member Services (800) 444-6222
Must contact Carrier to access Fax#
Varies depending on group #
Oxford USA (888) 201-4111
www.Oxfordhealth.com

 


  United
Click logo to connect
directly to United.

Enrollment-Change-Term Form  

United Health Care
Member Services (800) 357-0978
Mail Enrollment Material to:
P.O. Box 1946
Oldsmar, FL  34677
Or Fax to (813) 818-3724
www.UHC.com

 


© 2005 CPM Group
created by:
Influential Communications
CPM Group Insurance Services, Inc.
Group Insurance, Workplace Solutions, Financial Services

Local: 203-272-3521, ask for Katie at extension 162
Toll Free in CT only: 1-800-344-3501
Fax: 203-439-0516
90 Hinman Street, Cheshire, CT 06410
www.groupcpm.com