Employee Applications/Enrollment Forms:
Other Forms:
Employee Change of Status Form:
Use this form if you need to change your name, you need to add or delete dependents, or you need to change your beneficiary.
Change of Status Form (Online)
Change of Status Form (PDF)
Coordination of Benefits Form:
Use this form to let us know if you or any of your dependents are currently covered under any other health insurance policy in addition to your coverage with WMI Mutual Insurance™ Company.
Coordination of Benefits Information (Online)
Annual Employer Audit:
All employers must complete this form.
Employer Renewal Questionnaire (Online)
Accident Claims:
Use this form if we have requested accident information from you regarding a claim.
Electronic Payment Authorization Forms:
Electronic Payment Authorization (Online)
HIPAA Authorization for Release of Information:
Use this form if you need to give us authorization to request or release your protected health information.
Release of Information (Online)
Release of Information (PDF)