Broker Documents and Forms

General Forms and Documents - 2013		Proposal Request Forms
AGCOR Broker Renewal Highlights 2013 Underwriting Guidelines AGC Association Membership Information AGC OR - Become a Member - Information on Membership/Dues 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	Group Enrollment/Change/Waiver Form LifeMap Voluntary Products Enrollment Form Medical Plan Comparison BSI Reference Guide AGC Health Benefit Trust - Marketing Materials 2012 Single Page Flyer 2012 Single Page Flyer - Customizable for Broker Info	RFP/Quote Form (Word Document) Group Census Form (Must be submitted in Excel) Certification of Revenue from Construction
Renewal Forms	New Group Submission Forms
2013 Application 2013 Renewal Highlights Group Enrollment/Change/Waiver Form LifeMap Voluntary Products Enrollment Form	New Group Checklist 2013 Application Group Enrollment/Change/Waiver Form LifeMap Voluntary Products Enrollment Form SBC Group Acknowledgment Form Late Submission Application/Letter (If submission received after 15th) Regence Transition of Care Form (Optional) Regence Affidavit of Domestic Partnership	BSI EFT Form BSI COBRA Agreement BSI CDHP Enrollment Form(FSA, HRA, HSA)

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