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Agents, Employers, Members

Blue Card Program Information

PDF icon Blue Card Program Information.pdf

Agents

Business Associate Agreement

PDF icon Business Associate Agreement.pdf

Agents, Employers

Capital Selection 15.30.50 10-1-19

PDF icon Capital Selection 15.30.50 10-01-19.pdf

Agents, Employers

Capital Selection 15.30.50 10-1-19 20%

PDF icon Capital Selection 15.30.50.20 10-01-19.pdf

Agents, Employers

Capital Selection 15.50.100 10-1-19

PDF icon Capital Selection 15.50.100 10.01.19.pdf

Agents, Employers

Capital Selection 15.50.100 10-1-19 20%

PDF icon Capital Selection 15.50.100.20 10.01.19.pdf

Agents

CHPConnect - Agent Registration

PDF icon Introduction to Broker Portal 2021 - Fillable.pdf

Agents, Employers, Members

CHPConnect Agreement

PDF icon CHPConnect Agreement.pdf

Agents

CHPConnect Form - Agent

PDF icon CHPConnectForm.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

Agents, Employers, Members

Coordination of Benefits Instructions and Form

PDF icon Coordination of Benefits Instructions and Form.pdf

Agents, Employers, Members

Enrollment Application

PDF icon Enrollment Application 2023.87.EnrollApp.pdf

Agents, Employers, Members

Getting Care In A Disaster Area

PDF icon Getting Care In A Disaster Area.pdf

Agents, Employers, Members, Providers

Glossary of Health Coverage and Medical Terms

PDF icon Glossary of Health Coverage and Medical Terms.pdf

Agents, Employers, Medicare, Members, Providers

Health and Fitness Reimbursement Form

PDF icon Fitness Reimbursement Form 040820 FILLABLE.pdf

Agents, Members, Providers

J Code Med only update website 07 24

Agents, Employers, Members

LabCorp Frequently Asked Questions

PDF icon LabCorp FAQs.pdf

Agents, Employers, Members

LabCorp Locations

PDF icon LabCorp Locations.pdf

Agents, Employers, Members

Member Status Change Form

PDF icon Member Status Change Form 2020.pdf

Agents, Employers, Members

Non-Medicare Prescription Drug Reimbursement Request

PDF icon Non-Medicare Prescription Drug Reimbursement Request _ 2022 Updated.pdf

Agents, Employers, Members

Pregnancy And Coverage FAQ

PDF icon Pregnancy And Coverage FAQ.pdf

Agents, Employers

Premier PLUS Selection 15.30.50 10-1-19

PDF icon Premier PLUS Selection 15.30.50 10.01.19.pdf

Agents, Employers

Premier PLUS Selection 15.30.50 10-1-19 20%

PDF icon Premier PLUS Selection 15.30.50.20 10.01.19.pdf