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Get Quote!
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| Provider List |
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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.
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$aver One II (Empire) Downloads
Software
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Download
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SelectXpress Desktop Edition agent Quoting software. The new
SelectXpress Desktop Edition allows for the quoting of multiple
products and multiple plans, is easier than ever to use, and allows for
quicker and easier program updates. This software requires that you use
the "update" feature (under Help) at least every 30 days to insure you
have the most current rates, information and new products for which you
may have been recently appointed.
Additionally, please use the "update" feature as soon as you have
installed to make sure you get all products for which you are licensed
and the most current information. |
Applications
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Download
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Application for States: TN |
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Download
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Application Supplement |
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Download
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Authorization For The Release Of Medical Records |
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Download
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Request For Rewrite of Existing Health Insurance Coverage |
Brochures
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Download
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$aver One Brochure for The Association Group States: TN |
Licensing
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Download
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Commission Supplement |
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Download
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Direct Deposit Authorization Form 1/10/06 |
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Download
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IRS Form W-9 |
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Download
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New Application for Appointment & Assignment of Commissions |
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Download
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NEW Application for Appointment & Producer Agreement |
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Download
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New Appointment Checklist |
Miscellaneous
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Download
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$aver One Rate Calculation Worksheet 12/06 |
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Download
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American Select Field Underwriting Guide Insert for Ultimate Choice II, Health Logic, HealthNext and $aver One 8/05 |
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Download
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Authorization to Disclose Protected Health Information |
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Download
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Employers Acceptance of Payroll Deduction Plan (List Bill Forms ASIM-PDP-1-3 10/06) |
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Download
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Express Scripts 2006 Drug Formulary List |
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Download
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Express Scripts Pharmacies By State |
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Download
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HIPAA Eligibility Questionnaire |
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Download
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HSA - American Health Value Health Savings Account Brochure |
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Download
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HSA - HSA Bank Health Savings Account Brochure |
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Download
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HSA Q&A updated for 2007 |
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Download
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IAC PreScreen Form |
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Download
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Quick Reference Guide (Formerly the Field Underwriting Guide) |
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Download
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Risk Assessment Guide: Comprehensive Risk Assessment Guide |
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Download
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Select Fax Application Cover Sheet |
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Download
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Select Fax Instructions |
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Download
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Third Party Payor Plan Form and Patrons Statement of Eligibility & Authorization for 3rd Party Billing Form |
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Download
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Web SiteGuide |
Certificates/Riders/Specimen Policies
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Download
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Association Group States $aver One HSA Qualified Specimen Certificate for (AL*, AR*, AZ*, IL, IN*, MI*, MO*, MS*, NE*, OH*, PA*, SC*, TN, VA, WI*, and WV*) States with an asterisk require our additional State amendment rider. |
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Download
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Colorado $aver One HSA Qualified Specimen Policy |
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Download
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Georgia $aver One Indemnity HSA Qualified Specimen Policy |
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Download
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Georgia $aver One PPO HSA Qualified Specimen Policy |
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Download
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Texas $aver One Indemnity HSA Qualified Specimen Certificate |
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Download
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Texas $aver One PPO HSA Qualified Specimen Certificate |
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(Not responsible for translated content)
