Applications and forms
All you need to apply for Prevea360 health insurance
Small group options
Employers with 2 to 50 employees
Online quote
Online quoting available exclusively for small businesses (2-50 employees).
Small group options
2025
- Group plan book (PDF)
- Small group plan options (PDF)
2024
- Small group plan book (PDF)
- Small group plan options (PDF)
- Small group plan book (PDF en Español)
Applications and forms
- Employer group application (PDF)
- Employer group application (PDF en Español)
- Employee application (PDF)
- Employee application (PDF en Español)
Large group options
Employers with 51 or more employees
Large group options
2025
- Large group plan options (PDF)
- Group plan book (PDF)
2024
- Large group plan options (PDF)
- Large group plan book (PDF)
- Large group plan book (PDF en Español)
Applications and forms
- Employer group application (PDF)
- Employer group application (PDF en Español)
- Employee application (PDF)
- Employee application (PDF en Español)
- Large group checklist (PDF)
Other resources
- Underwriting guide
- Service area map
- TPA HRA authorization form
- Solicitation disclosure
- Waiver of coverage
- Employee health history
- Annual employer group size update