Employer documents
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2022 Administrative Guide
A booklet to help employers and HR representatives administer their Security Health Plan coverage
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2022 General Capabilities Brochure
Learn about Security’s plans, provider networks and options available for businesses. We have a plan to fit the needs of every employer
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2022 Large Employer Certificate
Provides specific coverage details for your policy
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2022 Transitional Employer Certificate
Provides specific coverage details for your policy
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Automatic Premium Payment Plan Common Questions
A list of common questions and answers for members about setting up an automatic premium payment plan
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Autorización para usar y divulgar información médica protegida (HIPAA, por sus siglas en inglés)
Utilice este formulario para designar a las personas que usted elija para que tengan acceso a su información médica
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Broker quoting checklist
A checklist designed to help brokers organize their quotes
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Care My Way @ Work
A handout for employers with details highlighting Care My Way @ Work
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Care My Way® Brochure
A brochure about our 24-hour Nurse Line and Care My Way® services
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Certificado de Empresa de Transición de 2022
Complete this form to add a domestic partner to your policy
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Certificado de Empresa Mayor de 2022
Proporciona detalles de cobertura específicos de su póliza
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Employee Health Insurance Application - with medical questionnaire
Employees of new fully insured large employers and new level-funded employers may complete this form to apply for coverage
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Employee Health Insurance Application - without medical questionnaire
Employees of new fully insured small employers and all existing employers may complete this form to apply for coverage
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Employer Automatic Premium Payment Plan
Information and form for employers about setting up an automatic premium payment plan
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Employer Group Access Request-Security Health Online
Employers should complete this form to get access to Security Health Online
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Employer Health Insurance Application
New fully insured large employers and new level-funded employers may complete this form to apply for coverage
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Employer Health Plan Change Request
A form that employers can use to submit a change in demographics, or add domestic partner coverage
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General Capabilities Brochure Flipbook
All the content from the General Capabilities Brochure PDF in a convenient online flipbook format for display purposes
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HIPAA Authorization to Use and Disclose Protected Health Information
Use this form to designate individuals you choose to have access to your health information
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Initial Electronic Enrollment Template
Employers can use this Excel spreadsheet to help organize their enrolled employee’s information
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Initial Electronic Enrollments Employer Guide
A guide to help employers fill out the Initial Electronic Enrollment Template with employee information
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Medication Coverage Options
Learn what drugs are covered with your plan, their cost and network pharmacies
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Member Prescription Drug Reimbursement Request
Complete this form to submit a prescription drug reimbursement claim
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My Security Health Plan Employer Portal Reference Guide
A guide to help you navigate the employer portal
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Premium Contribution Attestation
Complete this form with the percent you pay toward your employees’ premiums
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Renewal Questionnaire
A questionnaire for employers to complete and submit with their renewal paperwork
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Solicitud de seguro médico para empleados - con cuestionario médico
Los empleados de los grandes empleadores nuevos totalmente asegurados y los nuevos empleadores financiados por niveles podrían completar este formulario para solicitar la cobertura
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Solicitud de seguro médico para empleados: sin cuestionario médico
Los empleados de pequeños empleadores nuevos totalmente asegurados y todos los empleadores existentes pueden completar este formulario para solicitar la cobertura
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Special Enrollment Rights
A notice about special enrollment provisions
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Subscriber Change Request
Complete this form if you have a demographic change, plan change or the addition or deletion of a dependent
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Wellness Brochure
Learn about the wellness programs we offer employers to keep employees healthy and productive