Member Guidelines

Member Handbooks

Forms
Instructions When Completing Easy Choice Heath Plan Claim Form

Complete Sections 1-13 to the best of your ability
Complete new form for each member of the family that you are submitting medical expenses
New forms must be used on subsequent submissions
Photo-copy or faxes are not acceptable
Mail claims to address listed on upper right corner of HCFA 1500 form
Adherence to these guidelines will enable us to process your claims in at timely manner.


Employer Update/Termination/Deletion Form	Credit Card Authorization
Easy Choice Rewards Program Application	Enrollee Authorized Designee Form
Age 29 Enrollment Form - Group Employees	Age 29 Enrollment Form - Direct Pay.pdf
Member HIPAA Release Form	HealthWarehouse Generic Mail Order Form
Health Insurance Claim Form (HCFA 1500)

Other Resources

In addition, there are a variety of riders available to you and your employees which offer a number of prescription drug benefits, including mail order, vision benefits, student coverage and enhanced benefits for mental health/substance abuse and skilled nursing facilities.