Employers

For coverage written with Highmark Casualty Insurance Company, the following administrative forms are available to help you administer your group insurance policy.

General

Application for group insurance

Select

 

Application for stop loss insurance

Select

 

Supply requisition

Select

Employer Stop Loss

Aggregate stop loss claim

Select

 

Disclosure instructions

Select

 

Monthly aggregate report

Select

 

Specific stop loss claim

Select

Federal Forms

W-4 Forms

2004 W-4 2003 W-4

 

W-9 Forms

Select

 

Workers' Compensation

Occupational injury and disease report

Select