- 2019 CalCPA Subscription Agreement – Employer Application for all size firms – Your firm need only complete 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)
Groups with eligible employees can enroll online through the CalCPA Health enrollment area. This area offers group medical, dental, and vision plans – all available in one convenient enrollment process. Here you can get quotes on all the plans and choose the ones that best fit the needs of your firm. Once your firm submits its eligibility information and is approved to enroll, you can, at your discretion, allow your employees online access to enroll themselves and their family members.
HSA Forms and Information
- 2019 HSA Guidebook
- Three Ways to Contribute to your HSA Account (HealthEquity)
- HSA HealthEquity Enrollment Form
- HealthEquity HSA Administration – Employer
- IRS Form 8889
- IRS Form 8889 Instructions
For more information, call Banyan Administrators, Managers of the CalCPA Health programs, at 877.480.7923, email CalCPAHealth@CalCPAHealth.com or have your broker contact CalCPA Health at 650.522.3251.
Employer Notices - HIPAA
- Anthem Medical Claim Form
- Vision Service Plan Out-of-Network Reimbursement Request
- Delta Dental Claim Form
- Group LTD Claim Form
- International Claim Form
Express Scripts (ESI) Forms (Express Scripts for CalCPA Health PPO and HSA Plans) (877) 659-5144
IngenioRX Forms (for CalCPA Health HMO Plans) (833) 261-2465