The documents listed below are available for download. Please click on each title to download a PDF copy.

Individual Market

• RSDA/Wellmark Supply Order
• 5Star Life Insurance Company Term (All forms in 5Star Folder)

Group Market

• Group Quote Request Form
• Iowa Uniform Health Application N5401 (UHC & Wellmark Combined)
• Wellmark Rights and Responsibilities
• Wellmark New Account Quote Request (2-100) M53280
• Wellmark Health Only Application (N5408)
• Wellmark Health, Dental, Life Application (N5411)
• Wellmark Membership Change Form
• Wellmark PCP Form
• Wellmark MSP Form
• Wellmark Large Group Account Certification Form N53161
• UHC Employee Enrollment Form 2-99 SB.EE.07.IA
• UHC Employee Enrollment Form 51-99 SB.EE ONEQ.07 IA
• UHC Employee Enrollment Form 100+ LG.EE.07.IA
• UHC Employer Enrollment Application for Iowa 2-99 250.27.15
• UHC Employer Enrollment Application for Iowa 100+
• UHC Employer Enrollment Addendum 51-99
• UHC Iowa Uniform Group Health Application with Rights and Responsibilities
• Delta Dental Enrollment/Change Application
• Dearborn National Enrollment Form

Agent Support

• Agent Record Form
• ACH Authorization Form for RSDA
• RSDA Commission Statement PDF Authorization
• W-9 Form
• Wellmark Agent of Record Form AOR-1