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Insurance Forms Library

GROUP PRODUCTS INDIVIDUAL PRODUCTS

   Anthem Large Group

      All Forms
         Lumenos HRA Quote Request
         Lumenos HSA Quote Request
         Anthem Blue Access Large Group Quote Request
         Employee Enrollment 51+
         Anthem Large Group Employer Application
         Anthem Employer Questionnaire
         Quote Request Checklist 50+

   Anthem Small Group

      Enrollment Forms
         Anthem Missing Information Form
         Anthem Deductible Credit Form
         Anthem Electronic Funds Transfer Form
         Anthem Helpful Hints
         Anthem Enrollment Application 2-50
         Anthem Employer Application
         Anthem Enrollment Checklist

      Miscellaneous
         Anthem Underwriting Guide
         Anthem Group Administration Manual
         Anthem Transmittal Form
         Anthem Transmittal Guide
         Anthem Employee Change Form
         Anthem Subscriber Termination Form
         Anthem Participation Worksheet

      Quote Request
         Anthem Blue Access Quote Request 2-50
         Lumenos HIA
         Lumenos HIA+
         Lumenos HRA
         Lumenos HSA
         Lumenos Notes

   Humana

      applications
         OH HumanaOne Combined Application
         Employee Enrollment 51-99
         Employee Enrollment 2-50
         Employee Enrollment 10-99
         Medical Plan Selection
         Life Plan Selection
         Dental Plan Selection
         KY HumanaOne Combined Application
         Employer Group Application

   Medical Mutual of Ohio

      Large Group
         MMO 100+ Application
         MMO Employer Risk Assessment Form
         MMO 51+ Quote Check List

      Sales and Benefit Brochures
         MMO Sales Kit
         MMO Administrative Kit
         MMO Small Group Benefit Plans
         MMO Benefit Grid

      Small Group
         MMO Affidavit - New Groups Only
         MMO Deductible Credit Form
         MMO Contracts
         MMO Employee Application 20+
         MMO Employee Application 1-19
         MMO Employer Application
         MMO Enrollment Checklist

   UnitedHealthCare

      applications
         Direct Debit Authorization
         Employee Enrollment (Group Size: 51-99)
         Employee Enrollment (Group Size: 10-50)
         Employee Enrollment (Group Size: 2-9)
         Employer Application

   Anthem Blue Cross Blue Shield

      applications
         Anthem Short Term Application
         Anthem Individual Application
         Issue Age Application
         Attained Age Application
         Blue Access Application

      brochures
         Premiere Brochure
         Premiere Benefit Summary
         SmartSense Brochure
         SmartSense Benefit Summary
         Lumenos HSA Brochure
         Lumenos HSA Benefits
         Lumenos HIA Brochure
         Lumenos HIA Benefits
         Lumenos HIA Plus Brochure
         Lumenos HIA Plus Benefits
         Blue Access Value Brochure
         Blue Access Value Benefits
         Anthem Short Term Brochure
         Issue Age
         Attained Age

      questionnaires
         Gout
         Alcohol & Drug
         Arthritis
         Asthma / Allergy
         Attention Deficit Disorder
         Colitis
         Diabetes
         Digestive
         Ear
         Abnormal Pap Smear
         Fibromyalgia
         Seizure / Epilepsy
         Heart Murmur
         Hypertension
         Kidney
         Mental Health
         Migraine
         Spinal
         Thyroid
         Tumor
         Ulcer
         Endometriosis

   Humana

      applications
         Ohio Application

      brochures
         Portrait
         Monogram
         Total HSA Plus Rx
         Total HSA
         Share 80 Plus Rx & Copay
         Share 80 HSA
         Share 70 Plus Rx

   Medical Mutual of Ohio

      Medicare Supplement
         Medicare Brochure
         Medicare Guidelines
         Medicare Application

      Short Term
         Short Term Marketing Kit
         Short Term Application
         Short Term Plans

      SuperMed One
         List Bill Employee Agreement
         List Bill Employer Agreement
         Vision
         Dental
         Benefit Summaries
         Brochure
         Application

      SuperMed One OFB
         Benefit Summaries
         Marketing Flier
         Marketing Kit
         Ohio Farm Bureau Application

   Nationwide

      applications
         Prescreen
         OH PPO Choice
         OH Lifestyle
         Individual Application