Please open the application below. Print the form pages and complete, then mail to: The Capitol Group 4136 Innslake Drive, Glen Allen, VA 23060-3344
You may also fax the pages to (804) 741-9226
Employee Health Enrollment Application Group Size 2-14
Employee Health Enrollment Application Group Size 15+
The Capitol Group of Companies P.O. Box 70070 Richmond, Virginia 23255 Toll Free: (800) 527-0669 - Local: (804) 741-4444 - Fax: (804) 741-9226 Copyright 2008-2010. The Capitol Group of Companies. All rights reserved.
