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Thursday, September 09, 2010
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NOTE: You must have Adobe Acrobat Reader installed on your system to read forms. If you do not have it installed, click the button below to download it.
 

StarCare (Empire) Downloads

Software

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 use the "update" feature (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 use the "update" feature as soon as you have installed to make sure you get all products for which you are licensed and the most current

information.

Applications

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

Brochures

2/05 StarCare Brochure (Optimum & Cost Saver) for The Association Group States: TN

Licensing

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

Miscellaneous

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