RESOURCE CENTER

Installation Forms
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03.22.2012
Medical Health Questionnaire (2-50 employee size groups)
Form to be completed by all enrolling employees, in order to obtain a medically underwritten rate from IBC. Forms must be completed in full, and submitted after initial quote is run. Advise your account manager when you are ready to submit.
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01.10.2012
Application for New 51-99 Employer Health Benefits (released 8/2011)
IBC branded installation form to be completed by employer for new 51-99 eligible business
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01.06.2012
Renewal & Savings Form for 51-99
IBC branded renewal form to be completed by employer for new 51-99 eligible business. For employers making changes to the Blue Solutions PLUS products.
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12.21.2011
ACH Authorization form
In place of a paper check, group can pay initial premium via ACH. The attached form is required in order to do so, must be on group letterhead and signed by employer. This is a one time payment to be made within the date range specified in letter.
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12.20.2011
Employer HDHP Funding Certificate (51+ size groups)
Effective immediately, required for setup of any new business 51+ size group and for existing groups at renewal who offer or will offer an HDHP. Employer cannot fund more than 50% of the deductible.
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12.20.2011
Employer HDHP Funding Certificate (2-50 size groups)
Effective immediately, required for setup of any new business 2-50 size group and for existing groups adding an HDHP for the first time. Employer cannot fund more than 50% of the deductible.
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11.08.2011
2012 Small Group (2-50) submission calendar
IBC branded calendar of submission dates for 2012 for MUW and Installation. Deadline is still 15 days prior but if case is submitted for MUW by the 1st/15th prior, installation paperwork can be submitted by 8th/23rd prior.
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08.26.2011
IBC & Amerihealth BOR letter (for former AIC broker)
Sample of Broker of Record letter to be used for existing IBC/AHNJ clients. No other version will be acceptable.
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08.26.2011
IBC & Amerihealth BOR letter
Sample of Broker of Record letter to be used for existing IBC/AHNJ clients. No other version will be acceptable.
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08.05.2011
Employer Eligibility form
Form to be used when an owner/partner is not on a UC2 but rather files a Schedule K1, and eligibility must be certified.
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08.05.2011
Application for 2-50 Small Employer Health Benefits (released 8/2011)
IBC branded installation form to be completed by employer for new 2-50 eligible business
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08.03.2011
Renewal & Savings Forms
IBC branded renewal form to be completed by employer for new 2-50 eligible business. For employers making changes to the Blue Solutions products. *Contains the new ".1" series plans.
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06.29.2011
Amerihealth PA Enrollment form
Employee enrollment form to be used by someone who wishes to enroll into a Keystone group plan, yet resides in a non-contiguous county. Please consult with your Account Manager to discuss NCC rules and regulations.
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03.16.2011
IBC Universal Enrollment Form
Employee enrollment form
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03.16.2011
IBC Universal Enrollment Form (Spanish)
Employee enrollment form in Spanish
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