The following forms are being provided to assist you with the management of your Premier Access account.
All you need to access your currently enrolled employees’ data is to register on the home page of this website.
Employer Forms:
- Employer Enrollment Application
- Employer Application Checklist
- Vision Employer Application
- ACH Bank Draft Form
- Plus Plan Disclosure Form
Employee Forms:
- Employee Enrollment/Change Form (English)
- Employee Enrollment/Change Form (Spanish)
- Employee Enrollment/Change Form with Vision (English)
- Employee Enrollment/Change Form with Vision (Spanish)
- Individual Waiver Statement
- Individual Waiver Statement with Vision and SME
- COBRA Election Enrollment Form
- Dental Claim Form
- Dentist Nomination Form
- Grievance Form — PPO
- Grievance Form — DHMO
- HIPAA Authorization (English)
- HIPAA Authorization (Spanish)
Note: In order to view these forms, Adobe Acrobat Reader must be installed on your computer. To download Acrobat Reader, click on the adjacent “Get Acrobat Reader” button. 
