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11.30.2012
Billing & Collection Agreement (300+ size)
This agreement will be required for groups with 300+ enrolled lives. As of 1/1/13 renewals, IBC will no longer include commission as part of their premium. Rather they will collect a service fee for the broker, for which this agreement is required.
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11.13.2012
2013 Small Group (2-50) submission calendar
IBC branded calendar of submission dates for 2013 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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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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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.