HCG Documents and Forms

Benefits | Enrollment | Resource Information

Benefits

• Healthstyles Benefit Plan Summary (Mercy/UPH)
• 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

• HCG FAQs
• FAQs for Small Businesses
• Bare Period Information & FAQs
• Online Renewal Instructions
• HMO Group Service Agreement (Mercy/UPH)
• Mercy Healthcare Group Member Handbook
• UPH Member Handbook
• Allowable Preventive Codes
• Deductible-Exempt PX codes