Locations

Shelton Office

112 Huntington Street
Shelton, CT 06484
Phone: (203) 926-0001
Toll-Free: 888-397-3772

Middletown Office

573 Newfield Street
Middletown, CT 06489
Phone: (860) 346-9661
Toll-Free: 888-397-3772

Southington Office

276 North Main Street
Southington CT 06489

Benefit Forms

All benefit forms are available for download.You will need Adobe® Reader® installed on your computer to view the benefit forms.

Adobe® Reader® is free software that lets you view and print Adobe Portable Document Format (PDF) files on a variety of hardware and operating system platforms.

Carrier	Forms
Anthem Blue Cross	Anthem Enrollment/Change Form Dental Claim Form Group Family Health Statement Health Statement For Individuals Applying for Medicare Supplemental Plans H or J Mail Order Rx Form Medical Claim Form Prescription Drug Claim Form Termination Form
CBIA	CBIA Health Connections Enrollment/Change Form 3-50 CBIA Health Connections 2 Enrollment Change Form 3-50 CBIA Health Connections Family Health Statement 3-50 CBIA Health Connections Group Application 3-50 CBIA Health Connections Membership Application 3-50 CBIA Health Connections Student Verification Form 3-50
Cigna	Member Claim Form Prescription Drug Claim
Connecticare	Enrollment Change Form Domestic Partner Verification Family Health Statement Individual Enrollment Package & Health Statement Mail Order Rx Form Small Group Information Change Small Group Employer Application Student Verification
Guardian	Enrollment/Change Form Dental Claim Form Medical Claim Form
Oxford	Please contact your Broker or carolp@fwserra.com to obtain the correct form(s) needed for your Oxford Plan
Principal	Enrollment Form

If you are not finding the form(s) you need, please contact your Broker or chris@sdinsurancegroup.com to obtain the correct form(s) needed for your specific plan.

Testimonials

“Justin - Thanks so much for getting everything to me so quickly today. My mom is thrilled about the saving and she should be all set for Monday - I talked to John today and he is taking care of everything for Monday - he was great to work with today. And it is a small world - lol. Thanks again for your wonderful help with everything - talk to you soon”

-- Laura, P&C