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 – BlueCross BlueShield of Arizona
2020 Plan Year
Summary of Benefit Coverages
AZTC PPO 100/5000
AZTC PPO 100/7900
AZTC PPO 90/500
AZTC PPO 90/1000
AZTC PPO 80/500
AZTC PPO 80/1000
AZTC PPO 80/2000
AZTC PPO 80/3000
AZTC PPO 80/5000
AZTC PPO 80/6000
AZTC HSA 80/1500
AZTC HSA 80/3000
AZTC HSA 80/4500
AZTC HSA 100/3500
AZTC HSA 100/6900
Benefit Booklets
Coming soon!
Medical Marketing Material
Welcome Brochure
Teladoc Brochure
Heritage vs Heritage Prime Network Flyer
PrimePlus Care Member Brochure
PrimePlus Care Employer Brochure
Express Scripts Mail Order Flyer
Mobile App Flyer
Talkspace Flyer
Commonly Used Forms
Deductible & OOP Credit Form
Affidavit of Domestic Partnership
Certification of Disabled Dependent Form
Member Appeal Form
Authorization for Appeals Form
Express Scripts Mail Order Form
Benefit Booklets
Dental Plan Information
2019/2020 Plan Year
Dental Plan Highlights
Dental 750
Dental 750 w/ Ortho Coverage
Dental 1000
Dental 1000 w/ Ortho Coverage
Dental 1500
Dental 1500 w/ Ortho Coverage
Dental 2000
Dental 2000 w/ Ortho Coverage
Dental 2500
Dental 2500 w/ Ortho Coverage
Dental Plan Booklets
Dental 750
Dental 750 with Orthodontia
Dental 1000
2Dental 1000 with Orthodontia
2Dental 1500
Dental 1500 with Orthodontia
Dental 2000
Dental 2000 with Orthodontia
Dental 2500
Dental 2500 with Orthodontia
Dental Marketing Material
Dental Brochure
Vision Plan Information
2019/2020 Plan Year
Vision Benefit Summaries
Vision Preferred Plan
Vision Exam Plus
Vision Enhanced Plan
Vision Basic Plan
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
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
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