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Link
to Online Administration Log-in Page
Contact
Customer Service
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Carrier Forms: Health Net, Lifewise Assurance, VSP
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Other: COBRA & CDHP, Enrollment/Change/Waiver Forms, General Forms
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Lifewise
Assurance
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Back to Top
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Links
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Plan Certificates
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Plan Summary
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Lifewise Assurance Website
Administrative Forms
Beneficiary
Change Form
AGC
Group Life Claim Form
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$10,000 Base Life/AD&D
Certificate
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$10,000 Life/AD&D Plan Summary
$20,000 Life/AD&D Plan Summary
$30,000 Life/AD&D Plan Summary
$40,000 Life/AD&D Plan Summary
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Health Net
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Back to Top
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Links
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Benefit Summaries
( Aug11-Jul12 Plan Year)
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HealthNet
Website
How to Use Provider Search-PDF
Provider
Search
Pharmacy
Search
Administrative Forms
HIPAA
Authorization Forms
CVS
Caremark Rx Mail Order Form
CVS
Caremark Rx Mail Order Instructions
RX Reimbursement
Form
Miscellaneous Summaries
Pharmacy
Disclosure
Pharmacy
Benefit Guide
Domestic
Partner Rider
24 Hour
Coverage
Complimentary Care Network
Optum Health 877-369-2195
Optum Health - Complimentary Care 1/1/11
Optum Health Provider Directory
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PPO $250
PPO $500
PPO $750
PPO $1000
PPO $1500
PPO $2500
Value $500
Value $1000
Value $2000
RX $10/$20/$40
RX $15/$30/$50
RX $15/$35/$60
RX
$15/30%/50%
Plan Contract
PPO Plan Contract - 2011
PPO 2011 Summary of Contract Changes
HSA Qualified High
Deductible Plans
HSA
$2000 Single / $4000 Family
HSA RX 20%
(included with all HSA Plans)
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2009 and 2010 Benefit Summaries
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Vision
Service Plan (VSP)
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Back to Top
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Links
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Benefit Summaries (2011-12
Plan Year)
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VSP
Website
Provider
Directory
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Vision $10 / $25
Vision $0 / $10
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Guardian
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Benefit Summaries
Plan 1000
Plan 1500
Plan 2000
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Booklets
Plan 1000
Plan 1500
Plan 2000
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Guardian Rollover Flyer
Plan 1000 Rollover Flyer
Plan 1500 Rollover Flyer
Plan 2000 Rollover Flyer
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COBRA & CDHP –
Benefit Solutions, Inc. (BSI)
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Back to Top
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COBRA
BSI COBRA Administrative Agreement
Initial
Notice Template
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CDHP
BSI Cafeteria Plan Adoption Agreement
CDHP Group Enrollment Form
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General Forms
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Back to Top
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Enrollment/Change/Waiver
Form
Domestic Partner Affidavit
Program Highlights
Resources for Living EAP
Flyer
LifeBalance
Program Flyer
Health
Advocate Member Brochure
Health
Advocate Core Features
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Billing & Premium
Process
BSI Administrative Reference Guide
EFT Form, Terms &
Conditions
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