Broker Forms

To best serve our brokers, Children’s Community Health Plan has compiled a list of key forms to assist you. 

Agent Appointment Forms

• Business Associate Agreement
  
  

Enrollment Forms

• Enrollment Application
• Dental Enrollment Application
  
  

Miscellaneous Broker Forms

• Agent of Record Change Form
• Off-Exchange Cancellation Form
  
• PHI Release Form
• Tobacco Use Affidavit
• Automatic Payment Election Form​

Program and Benefit Flyers

• FoodSmart Program Overview 
• Get to know the FoodSmart App
• Get to know the BlueStar App
• CCHP on Call – Nurseline
• Healthy Mom Healthy Baby Program 
• Freespira Program Overview
• Together with CCHP Service Area