For Brokers.
Program Information
Benefits Program Information
General Information
Health Program Overview
Health Program Plan Descriptions 2020
Broker Commission ACH Form
Group Administrative Guide
HSA/FSA
HSA Product Flyer
FSA Product Flyer
HSA/FSA FAQ
HAS/FSA Implementation Guide
Plan Implementation Webinar Presentation
New Group Setup Paperwork
New Group Setup Application and Forms
New Group Setup Checklist
Group Master Application – 2020
Enrollment Census Template
Employee Enrollment Form – 2020
EFT Authorization Form
Membership Application
SIMON Access Request Form
Medical Plan Information – Blue Cross Blue Shield of Arizona
2020 Plan Year
Summary of Benefit Coverages
Benefit Booklets
Coming soon!
Medical Marketing Material
Commonly Used Forms
Appeal Grievance Request Form
Domestic Partner Affidavit
Mail-order Pharmacy Form
Deductible & OOP Credit Form
Certification of Disabled Dependent Form
Dental Plan Information – Blue Cross Blue Shield of Arizona
2020 Plan Year
Dental Plan Summaries
Dental Plan Booklets
AZTC DHMO High
AZTC PPO 50-1000 A Value
AZTC PPO 50-1500 A Value
AZTC PPO 50-1500 A2 Optimum
AZTC PPO 25-2000 A2 Optimum w/ 1500 Adult/Child Ortho
Dental Marketing Material
Dental Brochure
Vision Plan Information – VSP
2020 Plan Year
Vision Benefit Summaries
Vision Marketing Material
VSP Real Provider Choices Flyer
VSP Freedom to Choose Flyer
VSP Exclusive Member Benefits
VSP Exclusive Member Extras
VSP Eyeconic Overview with Benefit Integration
Life/AD&D & Disability – MetLife
Life/Supp Life/AD&D Plan Summaries
Basic Life $25K
Basic Life $50K
Basic Life $100K
Basic Life $250K
Supplemental Lifeife/Supp Life/AD&D
Life/Supp Life/AD&D Forms
Life Insurance Claim Form
Statement of Health Form
Supp Life Enrollment Form
Portability Application Form
Life Conversion Form
Life/Supp Life/AD&D Certificates
Basic Life $25K
Basic Life $50K
Basic Life $100K
Basic Life $250K
Supplemental Life
Long-Term Disability Plan Summaries
LTD Plan 1
LTD Plan 2
LTD Plan 3
LTD Plan 4
LTD Plan 5
Long-Term Disability Forms
LTD – Employee Statement Claim Form
LTD – Employer Statement Claim Form
LTD – Physician Statement Claim Form
Long-Term Disability Certificates
LTD Plan 1
LTD Plan 2
LTD Plan 3
LTD Plan 4
LTD Plan 5
Short-Term Disability Plan Summaries
LTD Plan 1
LTD Plan 2
LTD Plan 3
LTD Plan 4
Short-Term Disability Forms
STD Claim Form
Long-Term Disability Certificates
LTD Plan 1
LTD Plan 2
LTD Plan 3
LTD Plan 4
Marketing Material
MetLife Supporting Beneficiaries Flyer
MetLife Grief Counseling Flyer
MetLife Travel Assistance Flyer
Will Preparation FAQ – For Supp Life Clients Only
MetLife Contact Sheet
Portability vs. Conversion Flyer
Employee Assistance Program – Wellspring
Program Benefits & Marketing Material
Employee Benefits Summary
HR/Supervisor Benefits Summary
Benefit Flyer – Employee Facing
Benefit Flyer – HR Admin Facing
Broker Communications
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Legal Notices
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Credible Coverage Letter
Credible Coverage Notice
Summary Plan Description