Enrollment Forms and Additional Information
- Subscription Agreement
Employer Application for all-size firms—Your firm needs to complete only one subscription agreement regardless of how many group plans you elect. - Enrollment and Change Form (All employees must complete the form. Employees waiving coverage must complete the waiver section.)
- Medicare Secondary Payer (MSP) Statement (Applicable to firms with fewer than 20 employees)
- Automatic Deposit Authorization for Premiums Fillable
- Medicare Part D Credible Coverage
Delta (Dental)
- Member Claim Form Dental
- BrushSmart Flyer
- Go Paperless Flyer
- LifePerks – Savings to Smile About Flyer
- Pre-treament Estimate Flyer
- QualSight Lasik Discount Flyer
- Delta Resources at your fingertips
- Stay Connected Flyer
- Your One Stop Shop for Wellness Flyer
- Your Mouth and Your Body Flyer
- Wellness webinars Registration (2024)
VSP (Vision)
- Essential Medical Eye Care Flyer
- Exclusive Member Extras Flyer
- Extra $20 Spend Flyer
- Eyeconic Flyer
- Progressive Lens Flyer
- Savings Pass Flyer
- TruHearing Hearing Aid Discount Offer
- What Should I Expect at My Eye Exam
- Check Out vsp.com
- Diabetes and Your Eyes
- Healthy Heart Healthy Eyes
- Keep Your Eyes Healthy for Life
Claim Forms
- Anthem Medical Claim Form
- Delta Dental Claim Form
- Group LTD Claim Form
- Member Claim Form LTD CA
- Group Life Insurance Claim Form
Express Scripts (ESI) Forms (Express Scripts for CalCPA Health PPO and HSA Plans) (877) 659-5144
CarelonRx Forms (for CalCPA Health HMO Plans) (833) 261-2465