Group Benefits Administrators

BA Forms

2024-25 Forms

• Anthem Instructions for Ordering Materials
• Delta Dental Open Enrollment Packets Request
• Optima Materials Order Form
• TLC Enrollment Form
• TLC Enrollment Form - Spanish
• TLC Group Adjustment Form
• TLC Group Data Change Form
• TLC Group Employer Data Worksheet
• TLC New Group Employer Data Worksheet
• TLC Personal Data Change Form
• Adoption Agreement
• Adult Incapacitated Dependent Certification Form
• HIPAA Authorization Form
• Memo of Understanding (MOU)
• TLC Group Application

2023-24 Forms

• Anthem Instructions for Ordering Materials
• Delta Dental Open Enrollment Packets Request
• Optima Materials Order Form
• TLC Enrollment Form
• TLC Group Adjustment Form
• TLC Group Data Change Form
• TLC Group Employer Data Worksheet
• TLC New Group Employer Data Worksheet
• TLC Personal Data Change Form

Communications

• E-News
  • Past Issues
• BA Memos
  • Past Issues - Coming Soon

Resources

• Administrators Manual (LAM)
• Administrative Process Questions and Answers

Policies and Procedures

• Dependents Who Lose Eligibilty Due To Age
• Qualifying Life Events
• Adverse Experience Procedures
• Regulations