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Wednesday, September 08, 2010
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HealthNext (Empire) Downloads

Software

Download SelectXpress Desktop Edition agent Quoting software. The new SelectXpress Desktop Edition allows for the quoting of multiple products and multiple plans, is easier than ever to use, and allows for quicker and easier program updates. This software requires that you push the "update" button (under Help) at least every 30 days to insure you have the most current rates, information and new products for which you may have been recently appointed.

Additionally, please push the "update" button as soon as you have installed to make sure you get all products for which you are licensed and the most current information.

Applications

Download Application for States: TN
Download Application Supplement
Download Authorization For The Release Of Medical Records
Download Request For Rewrite of Existing Health Insurance Coverage

Brochures

Download American Select HealthNext Brochure For The Association Group States: TN

Licensing

Download Commission Supplement
Download Direct Deposit Authorization Form 1/10/06
Download IRS Form W-9
Download New Application for Appointment & Assignment of Commissions
Download NEW Application for Appointment & Producer Agreement
Download New Appointment Checklist

Miscellaneous

Download American Select Field Underwriting Guide Insert for Ultimate Choice II, Health Logic, HealthNext and $aver One 8/05
Download American Select HealthNext Rate Calculation Worksheet 11/06
Download Authorization to Disclose Protected Health Information
Download Employers Acceptance of Payroll Deduction Plan (List Bill Forms ASIM-PDP-1-3 10/06)
Download Express Scripts 2006 Drug Formulary List
Download Express Scripts Pharmacies By State
Download HIPAA Eligibility Questionnaire
Download IAC PreScreen Form
Download Quick Reference Guide (Formerly the Field Underwriting Guide)
Download Risk Assessment Guide: Comprehensive Risk Assessment Guide
Download Select Fax Application Cover Sheet
Download Select Fax Instructions
Download Third Party Payor Plan Form and Patrons Statement of Eligibility & Authorization for 3rd Party Billing Form
Download Web SiteGuide

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Bay Insurance Marketing, Inc.

Mailing Address P.O. Box 1575 | Palm Harbor, FL 34682
Street Address 3607 Alt U.S. 19 No. | Palm Harbor, FL 34683

(800) 878-9399 • (800) 878-9467 (fax)


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