Available forms for IAC Personal Health Plans
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IAC Personal Health Plans General Agent Contracting
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QuoteEz.net >>
Rating Software
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2008 Express Scripts Formulary
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Brochures and Plan Overviews
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IAC Personal Health Plans Brochure
IAC Personal Health Plans Brochure
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IAC PHP State Variations
IAC PHP State Variations
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IAC PHP Plan Overviews
IAC PHP Plan Overviews
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Applications and Forms
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IAC PHP HSA Addendum
IAC PHP HSA Addendum
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HSA Attestation Form
HSA Attestation Form
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IAC Personal Health Plans General Application
IAC Personal Health Plans General Application For use in AZ, AR, IL, IA, MI, NE, OH, OK, PA, SC, TN, TX, VA, WV, WI
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Alabama Application for Insurance
Alabama Application for Insurance
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Colorado Application for Insurance
For use in Colorado only.
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Florida Application for Insurance
Note: This download includes the Personal Health Plans Plan Selection Form
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IAC Personal Health Plans Application for Georgia
IAC Personal Health Plans Application for Georgia
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PHP Indiana Application
PHP Indiana Application
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Kansas Application for Insurance
For use in Kansas only.
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Missouri Application for Insurance (Association)
Note: This download includes the Personal Health Plans Plan Selection Form
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Montana Application
Montana Applicaton
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North Carolina Application for Insurance
For use in North Carolina only.
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New Mexico IAC Personal Health Plans Application
IAC Personal Health Plans Application
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South Dakota Application for Insurance
For use in South Dakota only.
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Health History Supplemental Form
Health History Supplemental Form
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Preferred Underwriting Form
Preferred Underwriting Form
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Prescreen Form
Prescreen Form
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Ancillary Benefits
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EyeMed Vision Plan Overview
EyeMed Vision Plan Overview
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Miscellaneous
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IAC SSL Producer Guide
IAC SSL Producer Guide
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Field Underwriting Guide
Field Underwriting Guide
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List Bill Election Form
Ind-LBEF (12/02)
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List Billing / Payroll Deduction Set-Up Form
Ind-PDLB 1-09
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Alabama List Billing / Payroll Deduction Set-Up Form
List Billing / Payroll Deduction Set-Up Form
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Premier Plan Colorado Health Plan Description Form
Premier Plan Colorado Health Plan Description Form
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Deluxe Plan Colorado Health Plan Description Form
Deluxe Plan Colorado Health Plan Description Form
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Copay Plan Colorado Health Plan Description Form
Copay Colorado Health Plan Description Form
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HDHP Plan Colorado Health Plan Description Form
HDHP Plan Colorado Health Plan Description Form
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Value Plan Colorado Health Plan Description Form
Value Plan Colorado Health Plan Description Form
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Replacement of Accident and Sickness Insurance Form
Replacement of Accident and Sickness Insurance Form. For use in Colorado only.
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Advantage Plan Colorado Health Plan Description Form
Advantage Plan Colorado Health Plan Description Form
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Sole Entity Form
Sole Entity Form
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Florida Sole Entity Form
Sole Entity Form
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OK Source of Payment Form (REQUIRED IF PAYING WITH BUSINESS CHECK)
OK SSL Source of Payment 1-09
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