ARMS Insurance Group - For Agents

Enrollment Forms (PA only)
Checklist (updated 2/9/09)
Employer Application (updated 2/9/09)
Employee Application (updated 2/9/09)
Enrollment Help
PA/NJ Calendar
Proof of Eligibility

Miscellaneous Forms
Sample Agent of Record
Enrollment Change Form
Associated Companies

top of page

Health Assurance/Health America

Enrollment Forms
Checklist (updated 4/9/09)
Employer Application (updated 1/5/10)
Employee Application (updated 6/23/10)

Miscellaneous Forms
Sample Agent of Record (updated 1/29/10)
Enrollment/Change Form (updated 7/27/07)
2009 Rx Drug Formulary (updated 11/11/08)
C3 Implementation Kit (updated 8/5/08)

top of page

HHIC

Enrollment Forms
Checklist (updated 7/28/10)
Employer Application (updated 7/28/10)
Employee Application (updated 5/4/10)

Miscellaneous Forms
Sample Producer of Record (updated 6/23/10)
HRA Small Group Setup Form (updated 5/4/10)

top of page

Highmark

Enrollment Forms
Checklist
Employer Application (updated 1/5/10)
Employee Application (updated 12/28/07)
Employee Application (managed care only)
Producer Transmittal Form
Waiver Application
UC2 Guideline (updated 9/8/09)

Miscellaneous Forms
Drug Reimbursement Form
Member Change Form (updated 12/28/07)
Request for Cancel (updated 6/1/07)

top of page

United HealthCare

Enrollment Forms
Checklist (2-50)
Employer Application (2-99) (updated 5/12/09)
Employee Application (2-99) (updated 4/1/09)

top of page

UPMC Health Plan

Enrollment Forms
Checklist
Employer App./Commitment Form
Broker of Record

Miscellaneous Forms
Sample Agent of Record
Enrollment/Change Form (updated 3/25/10)
Assist America
HSA Enrollment Form
HRA Group Setup Form (updated 6/23/10)
HRA Group Setup Tip Sheet (updated 3/4/10)
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.

top of page