RESOURCE CENTER

Installation Forms
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2016 Amerihealth 65 (GROUP) Employee application
2016 Application employee or retiree must complete to enroll in a Group sponsored Amerihealth 65 plan. Employer Plan Change Form (with rates) are also required and both should be sent to Brown & Brown 30 days in advance of effective date.
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2016 Plan Change Form (GROUP)
2016 form which employer must complete for NEW setup and change their existing Group sponsored Medicare Advantage plan. This form is for new and renewal submissions for 1/1/16 and is due by 10/18/16.
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2015 Plan Change Form (GROUP)
2015 form which employer must complete to change their existing Group sponsored Medicare Advantage plan. This form is only for renewal changes for 1/1/15 and is due by 10/15/14.
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2014 Amerihealth 65 (GROUP) Employee application
2014 Application employee or retiree must complete to enroll in a Group sponsored Amerihealth 65 plan. Group rates are also required and both should be sent to your account manager 30 days in advance of effective date.
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New Business Submission Guide (INDIVIDUAL)
This guide is for Amerihealth New Jersey and Independence Blue Cross INDIVIDUAL Medicare Advantage applications ONLY
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2014 New Business Cover Sheet - online application (INDIVIDUAL)
This form is required with every Individual Medicare Advantage IBC/AHNJ online application submitted through our office.
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2014 New Business Cover Sheet - paper application (INDIVIDUAL)
This form is required with every Individual Medicare Advantage IBC/AHNJ paper application submitted through our office.
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Appointment Program Agent Agreement
Before you can begin receiving pre-set appointments for prospective AHNJ Medicare eligibles, you must watch a webinar conducted by Ritter and then sign and submit the attached agreement . Attestation form is also needed.
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Calendar Attestation Form
Before you can begin receiving pre-set appointments for prospect IBC or AHNJ Medicare eligibles, you must watch a webinar conducted by Ritter and then sign and submit the attached attestation form.
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2014 Plan Change Form (GROUP)
2014 form which employer must complete to change their existing Group sponsored Medicare Advantage plan. This form is only for renewal changes for 1/1/14 and is due by 11/15/13.
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2013 Permission to Contact Card
The prospect is not obligated to complete the form. However, it must be completed if you are going to contact them at a future date with plan information and they not already a client of yours.
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10.31.2012
2013 Amerihealth 65 (GROUP) Employee application
2013 Application employee or retiree must complete to enroll in a Group sponsored Amerihealth 65 plan. Group rates are also required and both should be sent to your account manager 30 days in advance of effective date.
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11.22.2011
AmeriHealth 65 HMO (group) - 2012 Employee application
2012 Application employee or retiree must complete to enroll in AmeriHealth HMO 65 plan
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09.16.2011
Do’s & Don’ts in marketing Medicare Advantage products.
CMS branded release containing good informatin on the Do's and Don'ts when marketing Medicare Advantage products
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