Employee benefits
Employee benefits forms
Enrollment, change and claim forms for your group plans, and a benefits team ready to help you complete them.
Questions? Call (425) 242-5357
Forms
Forms we can send you
Forms vary by carrier and plan, so we send the current version for your group. Email benefits@firstunderwriters.com or use the request form below, and tell us if you need help completing one.
Health insurance
- Group health enrollment
- Qualifying event change form
- Dependent verification
- COBRA election form
Dental & vision
- Dental enrollment form
- Vision enrollment form
- Dental claim form
- Vision claim form
Life & disability
- Life insurance enrollment
- Beneficiary designation
- Evidence of insurability
- Disability claim form
FSA & HSA accounts
- HSA enrollment form
- FSA enrollment form
- Dependent care FSA form
- FSA reimbursement request
Retirement plans
- 401(k) enrollment form
- Contribution change form
- Beneficiary designation
- Rollover request form
Employer forms
- New group application
- Employee census template
- Section 125 plan document
- Employer contribution worksheet
Benefits assistance
How can we help?
Questions about your benefits or need help with enrollment? Our benefits team responds within one business day.
- New group quotes and renewal reviews
- Enrollment, plan changes and claims help
- Compliance and billing questions
Prefer to talk? Call (425) 242-5357, Monday–Friday, 8:30am–5:00pm Pacific.
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