855 - CYCOSMO (292-6766)

Health Insurance Resource Center

2024

Group Plans

AFA CPOSII 2500 80/50 $0LXR CY V23

AFA CPOSII 6750 100/50 CY V23

AFA CPOSII Premier 500 100/50 CY V23

AFA OAAS 500 80 $0LXR CY V23

2023

Individual Plans

Balance Care 1003

Balance Care 1007

Secure Care 1008

2023

Group Plans

Select Silver EPO HSA Local Value

Select Silver EPO Local Value 50/75

Select Gold EPO HSA Local Value

Select Gold EPO Local Value 30/60

Individual Plans

Gold HMO Regional Preferred 20/50

Gold EPO Regional Preferred 30/50

Silver EPO Regional Preferred 50/75

Silver EPO Local Value 50/75 HSA

Silver HMO Regional Preferred 50/75

Select Silver EPO Hospital Advantage 50/75 HSA

Select Silver EPO Advantage 25/6

2023

Group Plans

Gold HMO Regional Preferred 20/50

Gold EPO Regional Preferred 30/50

Silver EPO Regional Preferred 50/75

Silver EPO Local Value 50/75 HSA

Silver HMO Regional Preferred 50/75

Select Silver EPO Hospital Advantage 50/75 HSA

Select Silver EPO Advantage 25/6

2023

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

2023

Group Plans

OMNIA Silver BlueCard

OMNIA Silver HSA

OMNIA Silver Value

OMNIA Gold BlueCard

OMNIA Gold HSA BlueCard

OMNIA Platinum Value

Direct Access Gold

Direct Access Platinum 100/70 BlueCard

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 HSA Silver

OMNIA Silver Value

Advantage EPO Bronze

Advantage EPO Silver

Advantage EPO Essentials

Value Access Bronze

Value Access Silver

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.

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:

Broker Services:

201-533-7000(V) 201-533-7164(F)

Billing Services:

800-603-0125(V)

Broker Services:

1-800-355-2583(V)

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:

1-800-366-4148(V)

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

Large Group Certification

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

Medical/Dental/Vision Enrollment/Change Form
Mutual of Omaha NJ Medicare Supplement Application
Mutual of Omaha MD Medicare Supplement Application

Group Master Application
Small Group Master Application
2017 Enrollment/Change Form
New Jersey Forms

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

Ancillary

Small Employer Vision Group Application
Small Employer Dental Group Application
Horizon Health Plus Plan with Medical Application
Horizon Dental Waiver
Spending and Savings Account Forms

Enrollment Change Form
Statement of Responsibility
NJ Master Application
Metlife Binder Check Cover Form
Metlife NJ DHMO App
eCensus Format
Group Submission Application
Group Submission Disclosure Form

Individual

2018 IHC Application

Small Group

2018 Small Group Enrollment Eligibility Checklist
2018 Small Employer EFT Form
2018 Small Employer Master Application
2018 Small Employer Enrollment Change Form
2018 Small Group New Business Kit
2018 Small Employer Certification
2018 Small Employer Waiver

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

OptumRx Authorization Form

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

Ancillary

NEW- OBM Master Application rev. 9/2018
UHC Dental & Vision Enrollment Application
OBM Small Group Checklist
UHC Dental & Vision Master Application
OBM dental/vision employee application

2018 New Business Paperwork
2018 Transitional Care Form
2018 Enrollment Form
2018 Employee Waiver of Coverage
2018 Employer Certification
2018 Employer Plan Selection Form
2018 Participation Request/Contract
2018 Disable Dependent Form
Underwriting Tips &Tricks
List of new business requirements

USAble Census Template
Employee Enrollment Form
Small Group New Case Submission Materials
USAble Change Form

Products

Industries

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Contact Information

Phone: 855.292.6766

Fax: 732.363.3887

Locations

211 Boulevard of the Americas,
Suite 407, Lakewood, NJ 08701

50 Division Street, Suite 501
Sommerville NJ 08876

2 University Plaza Dr #100,
Hackensack, NJ 07601

Disclaimer

The information on this website is for informational and educational purposes only and is not a substitute for competent insurance, legal or tax advice and you should consult with a licensed professional in your state.

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Accredited Since: 8/22/2023

Years in Business: 15

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