Health Insurance Resource Center

HIPAA Authorization for Disclosure of Health Info Dental Claim Form Out of Pocket Maximum Reimbursement Form Davis Vision Reimbursement Claim Form
2018 AmeriHealth Individual Application ACH Credit Debit Card Form
Large Group
Large Group Certification
Future Scripts Rx Reimbursement Form 2-50
Small Group
2015 Small Group Waiver 2018 Small Group Account Installation Broker Checklist 2016 Small Group Dental Application 2018 SEH new business kit 2018 Small Group Master Application AmeriHealth HSA Acclaris Group Application AmeriHealth HSA Acclaris Transfer Decline Form AmeriHealth HSA PNC Group Application Electronic Withdrawl of Initial Payment Letter POS Claim Form Prior Carrier Deductible Credit Large Group Enrollment Form Large Group Underwriting Guidelines Future Scripts Rx Mail Order Form 2-50 PPO Claim Form Small Group Employer Certification DU31 Application Large Group Change Form Portal Access Form Small Group Member Application Future Scripts Rx Prior Authorization Form Guest Advantage Application Small Group Waiver of Coverage Handicap Child Claim Form Copay Reimbursement Form Plan Change Form Future Scripts Rx Reimbursement Form 51+ Declaration of Understanding 2018 Enrollment Change Request Form 2018 AmeriHealth Master Application
Medical/Dental/Vision Enrollment/Change Form
Mutual of Omaha NJ Medicare Supplement Application Mutual of Omaha MD Medicare Supplement Application
Group Master Application Small Group Master Application 2017 Enrollment/Change Form New Jersey Forms
Request To Represent a Deceased Member Deductible Carry Over Credit Report
2018 Horizon Individual Application 2017 Non-Group Enrollment/Change Request - NEW! 2017 Individual Termination Form Away from Home Care Services Application 2017 Individual Conversion Form 2017 Dental and Vision Non-Group Enrollment/Change Request
Large Group
51+ Request for Continuation of Enrollment for a Disabled Dependent 51+ Employee Application
Small Group
2017 Small Group Enrollment/ Change Request Spanish Version: Special Enrollment Documentation Requirements English Version: Special Enrollment Documentation Requirements 2017 Small Employer Certification 2017 Small Employer Waiver Auto Pay Application 2-5 Form Away From Home Care Services Application Conversion Request Form HSA Funding Form Mellon Paperwork Declaration of Understanding Small Employer Common Ownership Certification Spanish Version: New Group Application Spanish Version: Waiver of Coverage Spanish Version: Enrollment Change Form Horizon Health Plus Plan Application Highlighted Small Group New Business Paperwork Horizon Large Group Certification 2018 2018 SEH New Business Kit 2018 SHOP New Business Kit SEP & Documentation for Health Plans Purchased Off-Exchange Highlighted Small Group Enrollment/Change Request
Small Employer Vision Group Application Small Employer Dental Group Application Horizon Health Plus Plan with Medical Application Horizon Dental Waiver Spending and Savings Account Forms
Enrollment Change Form Statement of Responsibility NJ Master Application Metlife Binder Check Cover Form Metlife NJ DHMO App eCensus Format Group Submission Application Group Submission Disclosure Form
2018 IHC Application
Small Group
2018 Small Group Enrollment Eligibility Checklist 2018 Small Employer EFT Form 2018 Small Employer Master Application 2018 Small Employer Enrollment Change Form 2018 Small Group New Business Kit 2018 Small Employer Certification 2018 Small Employer Waiver
Health Insurance Claim Form HIPAA Member Authorization Exercise Facility Reimbursement Form Authorization for Broker to Act as Benefits Administrator Prescription Drug Reimbursement Claim Form
OptumRx Authorization Form
Small Group
2017 Small Employer Certification 2017 Small Employer Group Application 2018 Oxford OHP Small Group Application 2018 Oxford OHI Small Group Application Disability Questionnaire Oxford Direct Debit Authorization form NJ Small Group Forms General Forms Oxford Verification Form Oxford New York Small Group Application and Annual Certification Form NJ Small Group Tax Requirement Instruction Sheet Common Ownership Form for Affiliated Groups Sweat Equity Program Reimbursement Form
NEW- OBM Master Application rev. 9/2018 UHC Dental & Vision Enrollment Application OBM Small Group Checklist UHC Dental & Vision Master Application OBM dental/vision employee application
2018 New Business Paperwork 2018 Transitional Care Form 2018 Enrollment Form 2018 Employee Waiver of Coverage 2018 Employer Certification 2018 Employer Plan Selection Form 2018 Participation Request/Contract 2018 Disable Dependent Form Underwriting Tips &Tricks List of new business requirements
USAble Census Template Employee Enrollment Form Small Group New Case Submission Materials USAble Change Form
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