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Below you will find a list of commonly used forms for groups with WPS and Arise available for download. While we do the best we can to keep everything up to date, sometimes carrier websites change without our knowledge, which may mean step by step instructions may be out of date. If you notice anything doesn't work as intended, please bring it to our attention and we will correct it.
Please submit all completed forms to Shannon Herr:
Email: Shannon.Herr@hia-wi.com
Fax: 262-786-6731
Mail: Health Insurance Associates, Inc
Attn: Shannon Herr
19525 Janacek Ct STE 101
Brookfield, WI 53045
Type
Description
Form
WPS Enroll/Change/Term Form - 2-50 EE's ATNE
Can be used for any existing WPS group to enroll and terminate members, and make any information changes.
WPS Enroll/Change/Term Form - 50+ EE's ATNE
Can be used for any existing WPS group to enroll and terminate members, and make any information changes.
Arise Enroll/Change/Term Form
Can be used for any existing Arise group to enroll and terminate members, and make any information changes.
Domestic Partnership Declaration
Use this form to officially declare whether or not you will let your employees cover their domestic partners.
Employer Portal Access Instructions
Instructions on how to access the employer portal.
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