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AMERIHEALTH
- 2023 IHC Application
- 2022 IHC Application
- 2021 IHC App with Payment Info
- Davis Vision Reimbursement Claim Form
- HIPAA Authorization for Disclosure of Health Info
- Out of Pocket Maximum Reimbursement Form
- 2023 IHC Spanish enrollment form
- 2023 SEH Master Application
- 2023 SHOP Master Application
- 2023 IHC app- Spanish
- 2023 IHC app
- 2023 IHC BOR
- 2023 IHC Dental & Vision App- Spanish
- 2023 IHC Dental & Vision App
- Level Select Master App
- 2022 SEH Master App
- 2022 SHOP Master App
- 51+ Master Application
- 2022 IHC Application
- 2022 IHC Application- Spanish
- 2022 IHC Application-Dental/Vision
- 2022 IHC Termination Form
- Individual Term Form
- Disabled Dependent Form
- HSA Funding Form
- Horizon General Claim Form
- NEW HSA Setup Form effective 1/1/19
- Disabled Dependent Form
- Declaration of Understanding *New June 2021*
- Spanish Version: Waiver of Coverage
- Spanish Version: Enrollment Change Form
- Spanish Version: New Group Application
- Highlighted Small Group Enrollment/Change Request
- Small Employer Common Ownership Certification
- Request To Represent a Deceased Member
- Deductible Carry Over Credit Report
- Small Group Enrollment/ Change Request
- Spanish Version: Special Enrollment Documentation Requirements
- Small Employer Certification
- Small Employer Waiver
- Auto Pay Application
- 2-5 Form
- Away From Home Care Services Application
- Conversion Request Form
- AXA Member Enrollment Form
- AXA Member Enrollment Form w/Disability
- Davis Vision claim form
- IHC dental & vision app
- Bundle New Business Paperwork *New USAble app eff. 10/1/21*
- Horizon Dental Waiver
- Small Employer Vision Group Application
- Small Employer Dental Group Application
- Enrollment Change Form
- Statement of Responsibility
- Metlife Binder Check Cover Form
- Group Submission Disclosure Form
- eCensus Format
- 2021 Master Application
- 2021 Employee Application
- 2021 Waiver
- 2021 Certification
- 2021 PA IHC app
- NJ IHC app
- Payment Form for IHC
- Small Group EFT form
- Individual BOR template
- OXLF Enrollment form with MUW
- 51+ EE Enrollment Form
- EE Enrollment Form
- 2022 OHI Master App
- 2022 OHP Master App
- Group Contact/Address/Name Change Form
- Waiver
- 2021 Certification
- All Savers HIPAA form
- All Savers NJ enrollment form
- Oxford Verification Form
- NJ Small Group Tax Requirement Instruction Sheet
- Common Ownership Form for Affiliated Groups
- Sweat Equity Program Reimbursement Form
- Authorization for Broker to Act as Benefits Administrator
- Exercise Facility Reimbursement Form
- Health Insurance Claim Form
- HIPAA Member Authorization
- Prescription Drug Reimbursement Claim Form
- OBM Master Application
- UHC Dental & Vision Enrollment Application
- UHC Dental & Vision Master Application
- OBM Small Group Checklist
- OBM dental/vision employee application
Claims
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DELTA DENTAL
HORIZON
Individual
Large Group
Small Group
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MIG
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Claims
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