Documents & Forms Center

Agents

CHPConnect - Agent Registration

PDF icon Introduction to Broker Portal 2021 - Fillable.pdf

Employers

CHPConnect - Employer Registration

PDF icon Introduction to Employer Portal 2022 - Fillable.pdf

Employers

CHPConnect - Employer Registration

PDF icon Introduction to Employer Portal 2022 - Fillable.pdf

Agents, Employers, Members

CHPConnect Agreement

PDF icon CHPConnect Agreement.pdf

Agents

CHPConnect Form - Agent

PDF icon CHPConnectForm.pdf

Members, Providers

Clinical Guideline - Secondary Prevention for Patients with Atherosclerotic Vascular Disease 2023

PDF icon Vascular-Clinical-Guidelines-2023.pdf

Members, Providers

Clinical Guidelines - Diabetes Care 2023

PDF icon 2023-Diabetes-Clinical-Practice-Guideline.pdf

Members

Clone of State of Florida High Deductible Health HMO Plan SBC

PDF icon sof-standard-hmo-plan-sbc.pdf

CMS High Risk Medications

PDF icon CMS High Risk Medications.pdf

Providers

Colonoscopies Com

PDF icon Colonoscopies.pdf

Combating MCR Parts C and D FWA 122015

PDF icon Combating MCR Parts C and D FWA 122015.pdf

Commercial Member Grievance and Appeal Process

PDF icon Commercial-Member-Grievance-and-Appeal-Process.pdf

Medicare 2023, Agents, Members

Communication Directive Form

PDF icon Communication-Directive-Form.pdf

Agents, Employers, Members

Communication Directive Form Instructions

PDF icon Communication Directive 2020.pdf

Members

Consent Form for Minor Child

PDF icon Consent for Minor Child Approved 7 22 21_fillable.pdf

Members

Conversion Option A

PDF icon Conversion Option A.pdf

Members

Conversion Option C

PDF icon Conversion Option C.pdf

Members

Conversion Option C $10/$30/$50

PDF icon ConversionOptionC01-01-21.pdf

Conversion Option C $10/$30/$50

PDF icon Conversion Option C 1-1-24.pdf

Conversion Option C 1-1-22

PDF icon Conversion Option C 1-1-22.pdf

Conversion Option C-1-1-22

PDF icon conversion-option-c-1-1-22.pdf

Members

Conversion Option M $15/$30/$50

PDF icon ConversionOptionM01-01-21.pdf

Conversion Option M $15/$30/$50

PDF icon Conversion Option M 1-1-24.pdf

Conversion Option M 1-1-22

PDF icon Conversion Option M 1-1-22.pdf