Broker Documents and Forms

 2011 broker information can be found by clicking here

General Forms and Documents - 2012		Proposal Request Forms
AGCOR Broker Administrative Guide 2012 Underwriting Guidelines 2012 Renewal Booklet Medicare Secondary Payer / TEFRA Explanation AGC Association Membership Information AGC - Membership Dues 7-1-11 to 6-30-12 AGC - Benefits & Discounts - Value of Membership AGC - Retun on Investment (ROI of Membership) AGC - Workman's Compensation Mailer AGC - HR Answers AGC - Verizon Wireless Discount	Enrollment/Change/Waiver Form Approved SIC Codes Medical Plan Comparison BSI Reference Guide AGC Health Benefit Trust - Marketing Materials 2012 Single Page Flyer 2012 Single Page Flyer - Customizable for Broker Info Postcard Mailer #1	RFP/Quote Form (Word Document) Group Census Form (Must be submitted in Excel)
Renewal Forms	New Group Submission Forms
2012 Renewal Application 2012 Renewal Booklet	New Group Checklist Master Application Oregon Group Standardized Profile Form Late Submission Application/Letter (If submission received after 20th) HN Ongoing Care Form (Optional) HN Waiver Form (Optional) Authorization for Disclosure of "R" Numbers (Optional)	BSI EFT Form BSI COBRA Agreement (Groups of 20+) BSI CDHP Enrollment Form(FSA, HRA, HSA) State Continuation Form (Non-COBRA Eligible Groups)

If you have questions about obtaining an RFP or becoming an exclusive appointed broker, contact our broker relations department:

(971) 255-5359 or (866) 873-6175 or email us at: service@agchealthplansnw.com