Frequently Used Forms


		Forms

	Downloads
	Entire guide (pdf)	get Adobe Acrobat Reader (needed for pdfs)
	Underwriting guide (pdf)	get Adobe Acrobat Reader (needed for pdfs)
	Risk Management guide (pdf)
	Administration guide (pdf)
	Claims guide (pdf)

Business Partner's Guide main
Note: All forms are in Adobe pdf format and require Acrobat reader to open them. Clink the link above if you do not have this installed. All links open in a new browser window.
Potentially Catastrophic Loss List
Specific Advance Reimbursement
Specific Split-Funded Agreement
Specific Claim Form A
Specific Claim Form B
Liability Questionnaire
AFA Subrogation and Right of Recovery Reimbursement Agreement
QBE Subrogation and Right of Recovery Reimbursement Agreement
Higher Education Benefit Verification
Plan Eligibility/Work Status
Aggregate Summary Report
Year End Aggregate Claim
Aggregate Accommodation
Confidentiality Agreement
Attending Physician Statement
TPA Re-pricing Referral
Transplant Referral
Reinstatement Application
Acquisition Form

Business Partner's Guide main