Get a Quote Medical Carriers Aetna HealthAmerica Highmark BCBS/HHIC UPMC United Healthcare Useful Links Licensing Third Party Administrator PrimePay TASC Get a Quote Medical Carriers HealthAmericaOne Highmark BCBS UPMC Individual Advantage Short Term Medical Individual Dental Useful Links Licensing Medicare Advantage Carriers Coventry Advantra Highmark Medicare Medicare Supplement Carriers AARP-United Healthcare Mutual of Omaha Medicare PDP AARP Rx First Health Rx (Coventry) Highmark BlueRx Licensing Get a Quote Carrier-Branded Products BlueEdge Dental Coventry Dental HHIC Fashion Advantage UPMC Dental UPMC Vision Advantage Ancillary Products United Concordia Full Carrier Listing Licensing

	Health Care Get a Quote + Medical Carriers   Aetna   HealthAmerica   Highmark BCBS/HHIC   UPMC   United Healthcare Useful Links Licensing + Third Party Admin.   PrimePay   TASC		For Agents: Group Products, Medical Carriers UPMC Note: In browsers that launch PDF files within the window, you will need to click the back button to return to the site. Underwriting Guidelines | Enrollment Forms | Miscellaneous Forms | Product Grids Underwriting Guidelines Underwriting Guidelines 02/03/12 top of page Enrollment Forms Employee Application 11/03/11 Broker of Record 08/12/10 Enrollment Commitment Form 08/12/10 MBA Application 02/03/12 top of page Miscellaneous Forms Sample Agent of Record 10/01/10 Enrollment / Change Form 08/31/10 COBRA Advnatage Overview 02/03/12 HIA Group Setup Form 02/03/12 HRA Group Setup Form (Coinsurance Plans) 02/03/12 HRA Group Setup Form (100% Plans) 06/23/10 HRA Group Setup Tip Sheet 03/04/10 HSA Group Setup Form 02/03/12 Group Termination Form 03/14/08 Member Termination Form 07/15/09 Rx Direct Reimbursement Claim Form 07/15/09 Assist America 05/18/11 UPMC Product Portfolio 02/03/12 top of page Product Grids PPO Plans PPO $0  10-10  (15-30-50) 11/14/11 PPO $0  20-20  (15-30-50) 11/14/11 PPO $250  (15-30-50) 11/14/11 PPO $300  (15-30-50) 11/14/11 PPO $500  (15-30-50) 11/14/11 PPO $1250  (15-30-50) 11/14/11 PPO $2500 / 90%  (15-30-50) 11/14/11 PPO $300 / 80%  (15-30-50) 11/14/11 EPO Plans EPO $0  10-30  (15-30-50) 11/14/11 EPO $0  15-35  (15-30-50) 11/14/11 EPO $0  20-40  (15-30-50) 11/14/11 EPO $250  (15-30-50) 11/14/11 EPO $500  20-20  (15-30-50) 11/14/11 EPO $500  40-40  (15-30-50) 11/14/11 EPO $750  (15-30-50) 11/14/11 EPO $1000  (15-30-50) 11/14/11 EPO $1500  (15-30-50) 11/14/11 EPO  $250 / 80%  (15-30-50) 11/14/11 HRA Plans HRA PPO $1250 / 100%  (15-30-50) 02/03/12 HRA PPO $2500 / 100%  (15-30-50) 02/03/12 HRA PPO $1250 / 90%  (8-38-76) 11/14/11 HRA PPO $2500 / 90%  (8-38-76) 11/14/11 HRA PPO $3750 / 90%  (8-38-76) 11/14/11 HRA PPO $750 / 80%  (8-38-76) 11/14/11 HRA EPO $1250 / 90%  (8-38-76) 11/14/11 HRA EPO $2500 / 90%  (8-38-76) 11/14/11 HRA EPO $3750 / 90%  (8-38-76) 11/14/11 HRA EPO $750 / 80%  (8-38-76) 11/14/11 HSA Plans HSA PPO $1250 / 100%  (15-30-50) 02/03/12 HSA PPO $2500 / 100%  (15-30-50) 02/03/12 HSA PPO $1250 / 90%  (8-38-76) 11/14/11 HSA PPO $2500 / 90%  (8-38-76) 11/14/11 HSA PPO $3750 / 90%  (8-38-76) 11/14/11 HSA EPO $1250 / 90%  (8-38-76) 11/14/11 HSA EPO $2500 / 90%  (8-38-76) 11/14/11 HSA EPO $3750 / 90%  (8-38-76) 11/14/11 HIA Plans HIA PPO $1250 / 90%  (8-38-76) 11/14/11 HIA PPO $2500 / 90%  (8-38-76) 11/14/11 HIA PPO $3750 / 90%  (8-38-76) 11/14/11 HIA PPO $750 / 80%  (8-38-76) 11/14/11 HIA EPO $1250 / 90%  (8-38-76) 11/03/11 HIA EPO $2500 / 90%  (8-38-76) 11/14/11 HIA EPO $3750 / 90%  (8-38-76) 11/14/11 HIA EPO $750 / 80%  (8-38-76) 11/14/11 For current grids with alternate Rx drug plans, please contact our office. UPMC Dental & Vision information can be found on the "Carrier-Branded Products" page of the Ancillary Products. Download all UPMC Product Grids (ZIP) top of page
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