HEALTH INSURANCE RESOURCE CENTER
SBC
Contacts
Deadlines
Forms
FSA/HSA/HRA
INDIVIDUAL PLANS
GROUP PLANS
- Bronze Freedom NG 5800 50 EPO HSA
- Bronze Liberty NG 25-75 5750 70 EPO HSA
- Bronze Liberty NG 30-60 6750 80 PPO HSA
- Bronze Liberty NG 7000 100 EPO HSA
- Bronze Metro GT 40-75 6500 50 EPO HSA
- Bronze Metro GT 7000 100 EPO HSA
- Silver Freedom NG 25_50_2250_80 EPO HSA
- Silver Freedom NG 30-60 2000 80 PPO HSA
- Silver Freedom NG 40-70 3000 65 EPO
- Silver Freedom NG 40-70 3000 65 PPO
- Silver Freedom NG 50-100 100 EPO
- Silver Freedom NG 2000 70 EPO HSA
- Silver Liberty GT 25-50 4500 50 EPO
- Silver Liberty NG 25-45 5000 50 EPO
- Silver Liberty NG 25-50 2500 80 EPO HSA
- Silver Liberty NG 30-75 3500 60 EPO
- Silver Liberty NG 40-70 3000 65 EPO
- Silver Liberty NG 40-70 4500 60 EPO
- Silver Liberty NG 50-100 100 EPO ZD
- Silver Liberty NG 4000 80 EPO HSAM
- Silver Metro GT 30-80 3500 70 EPO
- Silver Metro GT 35-50 3500 70 EPO HSA
- Silver Metro GT 40-70 3000 65 EPO
- Silver Metro NG 30-80 3500 70 EPO ME
- Silver Metro NG 50-100 100 EPO ZD
- Platinum Freedom NG 5-15 100 EPO
- Platinum Freedom NG 20-40 100 EPO
- Platinum Freedom NG 20-40 100 PPO
- Platinum Liberty GT 15-30 250 90 EPO LA
- Platinum Liberty NG 5-35 500 100 EPO
- Platinum Metro GT 15-30 100 EPO
GROUP PLANS
- OMNIA Bronze
- OMNIA Silver
- OMNIA Silver BlueCard
- OMNIA Silver HSA
- OMNIA Silver Value
- OMNIA Gold
- OMNIA Gold BlueCard
- OMNIA Gold HSA BlueCard
- OMNIA Platinum
- OMNIA Platinum Value
- Direct Access Gold
- Direct Access Platinum 100/70 BlueCard
- HMO Platinum
- POS Platinum
- EPO Bronze 50 BlueCard
- EPO Silver 100/50
- EPO Silver 100/70
- EPO Silver 100/70 BlueCard
- EPO Silver BlueCard
- EPO Gold 100/40/60
- EPO Gold 100/40/60 BlueCard
- EPO Gold 100/80
- EPO Gold 100/80 BlueCard
- EPO Gold 100/80/50
- EPO Gold 100/23/45 BlueCard
- EPO Gold 100/25/40
INDIVIDUAL PLANS
- OMNIA Bronze
- OMNIA Silver
- OMNIA HSA Silver
- OMNIA Silver Value
- OMNIA Gold
- Advantage EPO Bronze
- Advantage EPO Silver
- Advantage EPO Essentials
- Value Access Bronze
- Value Access Silver
AMERIHEALTH
Claims
Individual
Large Group
Pharmacy
Small Group
2015 Small Group Waiver
2018 Small Group Account Installation Broker Checklist
2016 Small Group Dental Application
2018 SEH new business kit
2018 Small Group Master Application
AmeriHealth HSA Acclaris Group Application
AmeriHealth HSA Acclaris Transfer Decline Form
AmeriHealth HSA PNC Group Application
Electronic Withdrawl of Initial Payment Letter
POS Claim Form
Prior Carrier Deductible Credit
Large Group Enrollment Form
Large Group Underwriting Guidelines
Future Scripts Rx Mail Order Form 2-50
PPO Claim Form
Small Group Employer Certification
DU31 Application
Large Group Change Form
Portal Access Form
Small Group Member Application
Future Scripts Rx Prior Authorization Form
Guest Advantage Application
Small Group Waiver of Coverage
Handicap Child Claim Form
Copay Reimbursement Form
Plan Change Form
Future Scripts Rx Reimbursement Form 51+
Declaration of Understanding
2018 Enrollment Change Request Form
2018 AmeriHealth Master Application
CIGNA
DELTA DENTAL
HORIZON
Claims
Individual
Large Group
51+ Request for Continuation of Enrollment for a Disabled Dependent
51+ Employee Application
Small Group
2017 Small Group Enrollment/ Change Request
Spanish Version: Special Enrollment Documentation Requirements
English Version: Special Enrollment Documentation Requirements
2017 Small Employer Certification
2017 Small Employer Waiver
Auto Pay Application
2-5 Form
Away From Home Care Services Application
Conversion Request Form
HSA Funding Form
Mellon Paperwork
Declaration of Understanding
Small Employer Common Ownership Certification
Spanish Version: New Group Application
Spanish Version: Waiver of Coverage
Spanish Version: Enrollment Change Form
Horizon Health Plus Plan Application
Highlighted Small Group New Business Paperwork
Horizon Large Group Certification 2018
2018 SEH New Business Kit
2018 SHOP New Business Kit
SEP & Documentation for Health Plans Purchased Off-Exchange
Highlighted Small Group Enrollment/Change Request
HORIZON ANCILLARY
METLIFE
OSCAR
Individual
Small Group
OXFORD
Claims
Pharmacy
Small Groups
2017 Small Employer Certification
2017 Small Employer Group Application
2018 Oxford OHP Small Group Application
2018 Oxford OHI Small Group Application
Disability Questionnaire
Oxford Direct Debit Authorization form
NJ Small Group Forms
General Forms
Oxford Verification Form
Oxford New York Small Group Application and Annual Certification Form
NJ Small Group Tax Requirement Instruction Sheet
Common Ownership Form for Affiliated Groups
Sweat Equity Program Reimbursement Form
OXFORD ANCILLARY
QUALCARE
USABLE
AETNA | |
Broker Services: | 1-800-297-7145(V) 1-866-637-4329(F) |
Employer Services: | 1-888-287-4295(V) |
Enrollment Changes: | 1-866-682-3862(F) |
Navigator and Producer World: | 1-888-225-3375(V) |
For more detailed Aetna contact information, please see their contact sheet. | |
AMERIHEALTH | |
Customer Service: | 1-800-893-7827(V) |
Sales and Marketing: | 1-866-681-7368(V) |
Portal Technical Support: | 1-877-219-5453(V) |
Pharmacy: | 1-888-678-7012(V) |
Collections: | 1-215-241-3700(V) |
Individual: | Click here… | CIGNA |
Broker Services: | 201-533-7000(V) 201-533-7164(F) |
Billing Services: | 800-603-0125(V) |
HORIZON | |
Broker Services: | 1-800-355-2583(V) |
Broker Sales (Small Group/Ind): | 1-800-466-2583 |
Broker Services (Dental): | 1-800-433-6825 |
Billing Services: | 1-800-225-1955 |
Pharmacy: | 1-800-370-5088 |
OXFORD | |
Broker Services: | 1-888-201-4216(V) 1-603-897-4543(F) |
Financial Resources : | 1-800-366-4148(V) |
For more detailed Oxford contact information, please see their Producer Guide. |
AMERIHEALTH
Small Group New Business
- Last business day before the requested effective date.
- Effective date can be 1st or 15th of the month.
For a complete list of all 2017 small group new business and renewal deadlines, please click here.
Individual New Business
- 1 day before effective date.
- Effective date can be 1st or 15th of the month.
Conversion
- 15 business days prior to the effective date
CIGNA
- 15 business days prior to the 1st and the 15th of the month.
HORIZON
Small Group New Business
- 5 business days after the effective date.
- Effective date can be the 1st or 15th of the month.
Horizon 2018 Small Group Submission Dates
Individual New Business
- 2 days before the effective date (if paying with check).
- 1 days before the effective date (if paying with credit card).
- Effective date can be the 1st or 15th of the month.
OSCAR
- The deadline to submit applications for Small Group is 2 days prior to the start date.
- Groups have the option for either the 1st or 15th of the month effective dates.
OXFORD
- Day of the effective date.
- Effective date can be any day of the month.
- Please click here for Oxford’s 2018 Deadlines.
QUALCARE
- 15 days before the requested effective date (this is a soft deadline).
- Effective date can be the 1st of the month only.
For a complete list of all 2017 small group new business and renewal deadlines, please click here
Frequently Asked Question
1. What is a High Deductible Health Plan (HDHP)?
2. What is Health Savings Account (HSA)?
3. Who qualifies for an HSA?
4. Who can contribute to and are there any contribution limits for an HSA?
5. What rules must an employer follow when making HSAs available to their employees?
6. Where can I find a list of eligible medical and dental expenses which I can pay for with HSA funds?
7. What is a Health Reimbursement Account (HRA)?
8. Who qualifies for an HRA?
9. Who can contribute to and are there any contribution limits for an HRA?
10. What rules must an employer follow when making HRAs available to their employees?
11. What is a Flexible Spending Account (FSA)?
12. Who qualifies for an FSA?
13. Who can contribute to and are there any contribution limits for an FSA?
14. What rules must an employer follow when making FSAs available to their employees?