| Available forms for IAC
Personal Health Plans |
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2008 Express
Scripts Formulary
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Brochures and Plan Overviews
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IAC Personal
Health Plans Product Brochure
IAC PHP Bro 2-08
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Advantage Plan
Overview
Available Online
Only. One page overview of the Advantage Plan for the IAC
Personal Health Plans. |
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Deluxe Plan
Overview
Available Online
Only. One page overview of the Deluxe Plan for the IAC Personal
Health Plans. |
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High Deductible
Health Plan Overview
Available Online
Only. One page overview of the High Deductible Health Plan for
the IAC Personal Health Plans. |
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Daily Plan
Overview
Available Online
Only. One page overview of the Daily Plan for the IAC Personal
Health Plans. |
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Value Plan
Overview
Available Online
Only. One page overview of the Value Plan for the IAC Personal
Health Plans. |
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IAC: Brief
Overview
Learn more about
what IAC can do for your business. |
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Applications and Forms
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Florida
Application for Insurance
Note: This download
includes the Personal Health Plans Plan Selection Form
FL
FSL App (7-07)
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General
Application for Insurance
Note: This
download includes the Personal Health Plans Plan Selection
Form
For use in: AZ,IL,NE,NV,NM,OH,OK,TN,WV,WI
Form Number: Gnl FSL App (70307) |
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Ancillary Benefits
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Eyemed Vision Plan
Overview
Eyemed OV 10-24-02
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HSA
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HSA Set-up Form
for IAC Packaged HSA (Required if choosing automatic HSA set-up)
Individual HSA
Application addendum rev 11-2-04 |
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Miscellaneous
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IAC Individual
Health Plans Producer Guide
FSL Producer Guide
11/07 |
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Field Underwriting
Guide for the IAC Personal Health Plans
Use this guide to
understand the underwriting processes IAC uses. NOTE: 140 pages
Field Underwriting Guide (3/08) |
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List Bill Election
Form
Ind-LBEF (12/02)
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List Billing /
Payroll Deduction Set-Up Form
Ind-PDLB 12/02
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Confirmation of
Sole Employee Entity
Must be submitted
by business owners paying by business check in GA, KS, MI, NC, OK,
TN, VA
and WI |
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PHP State
Variations
PHP State
Variations 2-08 |
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IAC PHP Three Ways
to Apply
Review the three
ways your clients can enroll in IAC Personal Health Plans
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