The 360 Plan - AL,AR,FL,GA,IL,IN,NC,OH,TN,TX   Applications and Forms     Download » The 360 Plan Application – Includes Heath & Life The 360 Plan combination health & life application. Includes the Authorization for Release of Health-Related Information and the Monthly Automatic Payment Plan.AR,AL,IL,IN,NC,OH,TN,TX   Download » The 360 Plan Application – Includes Heath & Life The 360 Plan combination health & life application for Florida. Includes the Authorization for Release of Health-Related Information and the Monthly Automatic Payment Plan.     Download » The 360 Plan Application – Includes Heath & Life The 360 Plan combination health & life application for Georgia. Includes the Authorization for Release of Health-Related Information and the Monthly Automatic Payment Plan.     Download » Life Insurance Reinstatement Application - Standard TN,TX,IN,GA,AR Application and HIPAA authorization required to reinstate a life insurance policy     Download » Replacement Notice – Life Insurance or Annuity A Replacement Notice is required for each life insurance applicant. The Notice must be signed and dated by both the life insurance applicant and you, the product on or before the date of the insurance application. A copy of the signed Life Insurance Replacement Notice and all sales materials used during the sales presentation must be left with the life insurance applicant. OHIO   Download » MNL Appointment Kit for The 360 Plan Kit containing an appointment checklist, Requisition for Agent Appointment, Producer Agreement and Direct Deposit form.     Download » The 360 Plan Preferred UW Questionnaire Required form if applying for The 360 Plan preferred or super-preferred health rate. The preferred rate is available for applicants age 18-50 who qualify based on health history.     Download » Confirmation of Sole Employee Entity This form is to be completed by an applicant claiming sole employee entity status and requesting to submit a business check for the health insurance premium.   TENNESSEE ONLY   Download » The 360 Plan List Bill Instructions Instructions for establishing a list bill for the health insurance portion of The 360 Plan.     Download » The 360 Plan List Bill Set-Up Form This form is to be completed by an officer of the group requesting that health insurance premiums be set-up on a list bill.     Download » The 360 Plan List Bill Election Form This election form is to be completed by each applicant allowing their health insurance premium to be deducted on a list bill.     Download » List Bill Only – Monthly Automatic Payment Plan Required form if the applicant would like to pay premiums for The 360 Plan on a monthly basis through an automatic checking account bank draft or credit card payment and has elected to be part of a list bill.     Download » Freedom HSA Rollover Form This form should be used for a rollover or direct transfer from a previous HSA or MSA.     Download » Freedom HSA IRA Transfer Form to be used for a one-time contribution from your IRA.     Download » Freedom HSA Deposit Ticket This form should be used to make a deposit by check into an existing Freedom Health Savings Account.     Download » HSA Attestation Form Required form when applying for the HSA-Qualified plan and electing "Own HSA" in The 360 Plan quoting software. The form attests to the intent to open an HSA or that the applicant currently has an HSA.     Download » Freedom HSA ACH Form Freedom HSA form used to establish an automatic withdrawal or automatic deposit from an established bank account or other institution.     Download » Freedom HSA Application and Custodial Agreement Application to establish a Freedom Health Savings Account.     Brochures and Guides     Download » The 360 Plan Brochure Sales brochure for The 360 Plan containing information about the benefits available for health, life, critical illness and disability income insurance.     Download » Freedom HSA Brochure Small brochure containing the rules and benefits of an HSA along with the features of the Freedom HSA.     Download » The 360 Plan Producer's Guide Extensive guide containing information on new business, underwriting and inforce rules and procedures.     Download » The 360 Plan Disability Income Occupation List The Disability Income benefit rider is not available for every occupation. This list details which occupations are eligible for disability coverage.     Download » The 360 Plan Health Insurance Risk Evaluation Guide Large, comprehensive guide that details underwriting guidelines for The 360 Plan health insurance. This guide contains extensive information about specific medical conditions.     Download » The 360 Plan Life Insurance Rate Guide Life insurance guide for The 360 Plan which includes product information, underwriting guidelines and rates.   If you are using Internet Explorer 5.0 or earlier and experience a blank page when trying to view the above forms, try the following steps: Open the Adobe Reader on your system. Click on File, then Preferences, then General. The General Preferences window will open. In the Option section (at the bottom), UNCHECK the Web Browser Integration check box. Click on OK. Go back to iacusa.com and the Download Forms Page. Click on the form that you want to download. 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