Brokers Entity Forms Download

Brochures & forms for groups with 51+ employees. National provider network. Includes benefits for chiropractic/manual manipulation, acupuncture, massage therapy, naturopathy, dietetic counseling, heath products, and vitamin and minerals. (Not all products are available in all states.) The documents provided below are in PDF file format. To view and/or print these documents you will need Acrobat Reader installed.

BROCHURES

Sales Flyer
Chiropractic Study - Members with vs. Members without
Arizona Summary of Benefits
Arkansas Summary of Benefits
California EPO Summary of Benefits
California PPO Summary of Benefits
Colorado Summary of Benefits
Delaware Summary of Benefits
District of Columbia Summary of Benefits
Florida Summary of Benefits
Hawaii Summary of Benefits
Idaho Summary of Benefits
Illinois Summary of Benefits
Maryland Summary of Benefits
Michigan Summary of Benefits
Missouri Summary of Benefits
Nebraska Summary of Benefits
Nevada Summary of Benefits
New Mexico Summary of Benefits
Ohio Summary of Benefits
Oklahoma Summary of Benefits
Oregon Summary of Benefits
Pennsylvania Summary of Benefits
South Carolina Summary of Benefits
Texas Summary of Benefits
Virginia Summary of Benefits
West Virginia Summary of Benefits

FORMS

Group Election Form
Arizona Member Enrollment Form
Arkansas Member Enrollment Form
California EPO Member Enrollment Form
California PPO Member Enrollment Form
Colorado Member Enrollment Form
DC Member Enrollment Form
Delaware Member Enrollment Form
Florida Member Enrollment Form
Idaho Member Enrollment Form
Illinois Member Enrollment Form
Maryland Member Enrollment Form
Michigan Member Enrollment Form
Missouri Member Enrollment Form
Nebraska Member Enrollment Form
Nevada Member Enrollment Form
New Mexico Member Enrollment Form
Ohio Member Enrollment Form
Oklahoma Member Enrollment Form
Oregon Member Enrollment Form
South Carolina Member Enrollment Form
Texas Member Enrollment Form
Virginia Member Enrollment Form
West Virginia Member Enrollment Form
One-Time Census Layout Template
Monthly Membership Change Form
ASHIC Standard Producer Agreement '08
ASHIC Delaware Producer Agreement '08
ASHIC Florida Producer Agreement '08
ASHIC North Carolina Producer Agreement '08
ASHIC New Mexico Producer Agreement '08
ASHIC Oklahoma Producer Agreement '08
ASHIC Oregon Producer Agreement '08
ASHIC Pennsylvania Producer Agreement '08
ASHIC Virginia Producer Agreement '08
W-9 Form
HICN or SSN Alert
Reason for Refusal of HICN or SSN Form