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Employer Application Form
Employee Enrollment Form I
(groups with fewer than 20 employees)
Employee Enrollment From II
(groups with more than 20 employees)
Designation of Beneficiary Form
This form is needed for a member to designate the beneficiary for their
life insurance (not applicable to new groups).
Change Request Form
This form is required when a member needs to change the current information
related to their benefits such as adding new dependents, changing address,
changing marital status, etc. This form is also used for terminating an
employee's health coverage.
Please complete the necessary forms and send them to:
SIHO Insurance Services
417 Washington Street
Columbus, IN 47201
Fax: 812-348-4590
Attn: Carolyn Dailey
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