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Aetna | Health Assurance/Health America | Highmark | United HealthCare | UPMC Health Plan


Aetna

Enrollment Forms (PA only)
Checklist
Employer Application
Employee Application
Enrollment Help
PA/NJ Calendar
Proof of Eligibility
Miscellaneous Forms
Sample Agent of Record
Enrollment Change Form
Associated Companies


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Health Assurance/Health America

Enrollment Forms
Checklist
Employer Application
Employee Application (updated 4/3/08)
Broker of Record - New Business
Miscellaneous Forms
Sample Agent of Record
Enrollment/Change Form (updated 7/27/07)
2008 Rx Select Member Drug Formulary (updated 2/27/08)


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Highmark

Enrollment Forms
Checklist
Employer Application (updated 10/3/07)
Employee Application (updated 12/28/07)
Employee Application (managed care only)
Producer Transmittal Form
Waiver Application
UC2 Guideline
Miscellaneous Forms
Sample Producer of Record (updated 8/21/07)
Administrative Billing Guide
Drug Reimbursement Form
Member Change Form (updated 12/28/07)
Request for Cancel (updated 6/1/07)


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United HealthCare

Enrollment Forms (all updated 10/3/07)
Checklist (2-50)
Employer Application (2-99)
Employee Application (2-19)
Employee Application (20-99)
Employer Questionnaire (20-99)
Miscellaneous Forms (all updated 10/3/07)
1099 Independent Contractors Form
Additional Dependants Form
Common Ownership Form (2-50)
Employer eServices Form
Health Insurance Claim Form
HRA Benefit Form
Mail Order Prescription Form
Online Payment Remittance Form
Pharmacy Reimbursement Claim Form
Scheduled Direct Debit Form


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UPMC Health Plan

Enrollment Forms
Checklist
Employer App./Commitment Form
Employee Application* Sample Only
Broker of Record
Miscellaneous Forms
Sample Agent of Record
Enrollment/Change Form
Assist America
HSA Enrollment Form
RX Direct Reimbursement Claim
Student Verification Form
Member Termination Form
Group Termination Form (updated 3/14/08)

* UPMC requires the original, sealed copies. Please contact our office (412-835-9100) to request applications.

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