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HCG Home | Currently Enrolled | Non-Grandfathered | Documents & Forms

HCG Documents and Forms - Non-Grandfathered

Benefits

  • Healthstyles Benefit Plan Summary (Mercy/UHG)
  • Advantage Vision Care Benefit Summary (Avesis)
  • Employers Dental Services - Enrollment and Coverage Booklet
  • Principal Plan Dental PPO Benefit Plan Summary
  • Using Dental Network Providers

Enrollment

  • Employee/Dependent Enrollment/Change Form
  • Employee Checklist
  • Member Health History Form
  • Termination Form
  • Group Enrollment/Change Form
  • New Group Enrollment Packet
  • Authorization Agreement for Automatic Debit
  • Acknowledgement of Receipt - Healthcare Group of Arizona Dental Plans
  • Acknowledgement of Receipt - Avesis Advantage Plus Vision Benefits
  • Proof of Business Checklist

Resource Information

  • 2012 Silver and Copper Plans Group Service Agreement
  • 2012 Silver and Copper Plans Member Handbook
  • HCG FAQs
  • FAQs for Small Businesses
  • Bare Period Information & FAQs
  • Online Renewal Instructions
  • Allowable Preventive Codes (temporarily unavailable)
  • Deductible-Exempt PX codes (temporarily unavailable)

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