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Aetna | Assurant | Dominion Dental | Health Plan Administrators | HealthAmerica One | Highmark


Aetna

2008 Aetna Broker Brochure (updated 3/27/008)
Aetna Enrollment Form (updated 3/27/008)
PPO Joinder Agreement.pdf

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Assurant

Assurant Health STM Application (updated 10/23/09)

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Dominion Dental

Dominion Dental Invitation.doc
Teethkeepers Powerpoint.pdf


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Health Plan Administrators

OverSeasTravelApplication.pdf

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HealthAmerica
One


Enrollment Forms
Gold Standard Enrollment Form (updated 6/23/10)
Pre-Ex Acknowledgement Form (updated 9/15/09)

Misc. Forms
Bank Debit Change From
Broker Submission Cover Sheet (updated 9/9/09)
Cancellation Form (updated 4/28/08)
Literature Request Form (updated 9/15/09)
Medical Records Release Form (updated 11/11/08)
Payroll Deduction Authorization Form (updated 7/3/08)
Rx Drug Formulary (updated 8/13/09)
Vision Flyer (updated 2/9/09)


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Highmark


Enrollment Forms
DirectBlue (updated 8/13/09)
PPOBlue (updated 8/13/09)
ShortTermBlue (updated 8/5/08)
Special Care (updated 8/5/08)

Misc. Forms
HIPAA Checklist (updated 6/30/09)
Individual Change Form (updated 6/30/09)
Keystone Replacement Form
Medical Records Fax Cover Sheet.doc (updated 3/4/08)
Producer Manual (updated 12/15/09)
Replacement of Coverage Form
See What's New Vision Brochure
ShortTermBlue Overview (updated 8/5/08)
ShortTermBlue Producer Certificate (updated 4/7/09)
ShortTermBlue Rx Drug Claim Form (updated 8/5/08)
SpecialCare Overview (updated 8/5/08)
SpecialCare Rate Sheet (updated 8/5/08)


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