Forms & Resources

Use these resources to better manage your plan. We now offer form submission via DocuSign on many items, to help you save time and streamline the submission process. If you have questions or need additional guidance or information, contact your agent.

General Resources

Employer Portal Authorized Access

Complete and submit this information as your group’s authorized representative to have access to the Employer Portal.

Specialty Drug List

Use this resource to understand what specialty drugs are part of your plan.

Online Formulary Tool

Use this resource to see the full range of prescription drugs available. You’ll be directed off this site to th MagellanRx Website.

Request for Appointment of Personal Representative Form

Plan Members must complete this information to release PHI to a provider or other party.

Employer Disability Claim

Employer Death Claim

SafeGuard logo

Illinois Resources

Employee Enrollment Form

Indiana / Ohio Resources

Employee Enrollment Form

Michigan Resources

Employee Enrollment Form

Wisconsin Resources

Employee Enrollment Form

Large Group Insured

Michigan Resources

Employee Enrollment Form

Metal Plans

Michigan Resources

Employee Enrollment Form

Ohio Resources

Employee Enrollment Form

Wisconsin Resources

Small Group Employer Uniform Employee Application

Indiana Resources

Employee Enrollment Form