Broker Documents and Forms

2011-12 Renewal Booklet

2011-12 Plan Comparison

2011-12 Renewal Application

BSI Reference Guide

2011 Alaska Renewal Presentation
(Adobe PDF)

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

service@agchealthplansnw.com

General Forms and Documents
AK Underwriting Guidelines Medicare Secondary Payer / TEFRA Explanation	AK Employee Enrollment Form		Approved SIC Codes
New Group Submission Forms
New Group Submission Forms New Group Checklist New Group Application Individual Health Statements (Groups 2-50) Individual Health Statements (Groups 51-99)		EFT Form COBRA Agreement (Groups of 20+) Late Submission Application/Letter
Proposal Request Forms
RFP Form	Group Census Form       WWWebmaster		Health Risk Questionnaire