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Form
Beneficiary Designation Form
Change Notice – Authorized Contact/Plan Administrator/Employer Portal Users Form
Prosum – Health Assist Link Application Form
Prosum – Health Assist Zone Application Form
Online Administration User Agreement Form (Employers)
The OASSIS administration system will allow our clients to perform administration functions within a secure, web-based environment in accordance with the...
Group Transmittal Form (Employers)
All benefit and / or coverage changes must be received by OASSIS within 31 days of the benefit eligibility date or the date of a qualifying life event under...
Dependent Children Over Age 21 Form
Your unmarried child between the age 21-25, if enrolled and in full-time attendance at an accredited college, university or educational institute that is...
Member Benefit Change Form
A change request to add health and dental coverage due to a Qualifying Life Event must be submitted to OASSIS within 31 days from the life event. If written...
Pre-Authorized Payment Form (Employers)
Please complete this form to set-up pre-authorized payments or to change the banking information for the monthly group benefit premium withdrawals....