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	Health Care Get a Quote + Medical Carriers   HealthAmericaOne   Highmark BCBS   UPMC Individual Adv. Short Term Medical Individual Dental Useful Links Licensing		For Agents: Individual Products, Medical Carriers HealthAmericaOne Note: In browsers that launch PDF files within the window, you will need to click the back button to return to the site. Rate Sheets | Enrollment Forms | Miscellaneous Forms | Product Grids Rate Sheets Rate Sheets (Effective 1/1/12) Central PA (Area 1) 02/03/12 Central PA (Area 2) 02/03/12 Central PA (Area 3) 02/03/12 NWPA 02/03/12 Ohio 02/03/12 Philly Area 02/03/12 SEPA 02/03/12 SWPA (Area 1) 02/03/12 SWPA (Area 2) 02/03/12 Rate Sheets (Effective 4/1/12) Central PA (Area 1) 02/11/12 Central PA (Area 2) 02/11/12 Lancaster, Lebanon 02/11/12 Ohio 02/11/12 Philly Area 02/11/12 SEPA 02/11/12 Western PA 02/11/12 top of page Enrollment Forms Gold Standard Enrollment Form 02/03/12 top of page Miscellaneous Forms Bank Debit Change Form 10/18/10 Broker Submission Cover Sheet 05/18/11 Literature Request Form 05/18/11 Payroll Deduction Authorization Form 07/03/08 Plan Cancellation Form 02/03/12 Plan Change Form 11/19/10 Rx Drug Formulary 05/18/11 Vision Flyer 02/09/09 top of page Product Grids Plan Summaries HAOne PPO Products (One-Pager) 09/30/11 HAOne Embedded Dental Benefit 08/11/10 Choice1 PPO Plans Choice1 PPO $1250 09/30/11 Choice1 PPO $2000 09/30/11 Choice1 PPO $4000 09/30/11 Copay Plans Copay 100% $0 $20/$40 09/30/11 Copay 100% $0 $25/$50 09/30/11 Copay 100% $1200 09/30/11 Copay 90% $750 09/30/11 Copay 90% $1000 / $2K OOPM 09/30/11 Copay 90% $2000 09/30/11 Copay 80% $500 09/30/11 Rewards Rewards $1750 85% 07/12/11 Rewards $2500 85% 07/12/11 Rewards $5000 85% 07/12/11 QHDHP Plans w/o HSA QHDHP 100% $1250 10/01/10 QHDHP 100% $2500 10/01/10 QHDHP 100% $3750 10/01/10 QHDHP 90% $1500 10/01/10 QHDHP 90% $3000 10/01/10 top of page
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