Moda Health forms and guides
Get the tools you need to successfully onboard and manage your clients. From administrator guides to electronic services agreements, this page houses the essentials for setting up and supporting a Moda Health plan.
Group Administrator Guide
Explore our overview of roles, processes and key contacts for managing group coverage.
Transition checklist
Help your clients smoothly switch to Moda Health with this step-by-step onboarding checklist.
Group applications and plan confirmation
Find everything you need to set up small and large group coverage with Moda Health, including applications by group size and plan year, and confirmation forms to finalize selections.
Group applications
2026 Small Group (1-50 employees) application
2026 Large Group (51+ employees) application
Confirm whether your client qualifies as a small or large group under ACA guidelines:
Enroll new or renewing groups:
Plan confirmation forms
Set up electronic funds transfer for group premium payments:
2026 Small Group Plan Confirmation form
For groups submitting paperwork after the effective date:
Agreements and authorizations
Set up electronic funds transfer for group premium payments:
Authorization agreement form (EFT) - Group
For fully insured groups with 51+ enrolled employees:
Electronic Services Agreement – 51+ Fully Insured
For self-funded groups using administrative services only (ASO) plans.
Electronic Services Agreement – ASO:
Authorization form allowing the disclosure of protected health information to another person/entity:
Individual and family plans
Access individual and family plan applications to help enroll members with confidence.
Medicare Supplement applications
Help clients get more from their Medicare with Moda Health’s Medicare Supplement plans.
- 2026 AK Medicare Supplement application
Enrollment and change forms
Find the right enrollment form for your group’s setup, whether it’s medical, dental or a combination. Most forms are also available in Español
Standard enrollment forms
These forms are for new enrollments and member changes.
Domestic partnership declarations
Claims and coordination forms
Help your clients navigate claims submissions and benefits coordination with these downloadable forms.
Members can submit out-of-network medical or vision claims:
Members can view this form by logging in to their Member Dashboard:
Dental claim form on Member Dashboard
Use this form for reimbursement of tobacco cessation program expenses:
This form is required when a member has other health coverage:
Have questions?
Your Moda Health sales team is here to help you compare options, generate quotes and find what you need.