Health Insurance Resource Center


Individual Plans

Group Plans
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


Broker Services:
1-800-297-7145(V) 1-866-637-4329(F)
Employer Services:
Enrollment Changes:
Navigator and Producer World:
For more detailed Aetna contact information, please see their contact sheet.

Customer Service:
Sales and Marketing:
Portal Technical Support:
Pharmacy:
Collections:
Individual:


Broker Services:
Broker Sales (Small Group/Ind):
Broker Services (Dental):
Billing Services:
Pharmacy:

Broker Services:
1-888-201-4216(V) 1-603-897-4543(F)
Financial Resources:
For more detailed Oxford contact information, please see their Producer Guide.

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

15 business days prior to the 1st and the 15th of the month.

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.

- 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.

- Day of the effective date.
- Effective date can be any day of the month.
- Please click here for Oxford’s 2018 Deadlines.

- 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

Claims
HIPPA Authorization for Disclosure of Health Info
Dental Claim Form
Out of Pocket Maximum Reimbursement Form
Davis Vision Reimbursement Claim Form
Individual
2018 AmeriHealth Individual Application
ACH Credit Debit Card Form
Large Group
Pharmacy
Future Scripts Rx Reimbursement Form 2-50
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


Claims
Request To Represent a Deceased Member
Deductible Carry Over Credit Report
Individual
2018 Horizon Individual Application
2017 Non-Group Enrollment/Change Request – NEW!
2017 Individual Termination Form
Away from Home Care Services Application
2017 Individual Conversion Form
2017 Dental and Vision Non-Group Enrollment/Change Request
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




Claims
Health Insurance Claim Form
HIPAA Member Authorization
Exercise Facility Reimbursement Form
Authorization for Broker to Act as Benefits Administrator
Prescription Drug Reimbursement Claim Form
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

