Health Insurance A-Z Forms for Brokers

Ancillary Services Administration Agreement
aptihealth | The Mental Health App
Asthma Management Flyer
Before You Leave Town- Travel Out Of Area
Benefit Wallet Health Savings Account (HSA) Education Materials
Benefit Wallet Health Savings Account (HSA) Employer Materials
Brave Health Member Flyer
Breastfeeding Support
Broker of Record (BOR) Letter Template
CDPHP Health Hub Employer Broker Flyer
CDPHP Health Hub - Member User Guide
CDPHP Health Hub Member Flyer, powered by Virgin Pulse
CDPHP Overview
CDPHP Care Team
Changes You Should Know
Claims Reimbursement Form - Vision & Medical
Commercial Rating Region Map
Complete Wellness Guidelines for Adolescents
Complete Wellness Guidelines for Children
ConnectRx On The Go Employer Flyer
Copay First Employer/Broker Brochure
Copay First Member Tip Sheet
Coronavirus Coverage and Prevention Tip Sheet
Customer Connect
Delta Dental Claim Form
Delta Dental Plan Selection Form 2023 | 2022
Delta Dental SmileWay
Diabetes Prevention Program Reimbursement Form
Diabetes Resources and Support Flyer
Digital Classes Gym Reimbursement Flyer
Doctor on Demand
Doctor on Demand - Mental Health
Doula Reimbursement Form/Flyer
Drug Coverage Flyer
eExchange Enrollment and Renewal Flyer
Electronic Reimbursement Form - Members
Embrace Claim Form
Embrace Health Employer Flyer
Embrace Health Bonus Flyer
Employee Enrollment Application / Change Form
Employer Application Form
Employer Group Attestation
Enhanced Primary Care Employer Brochure
Enhanced Primary Care Member Tip Sheet
Family Health Resources Flyer
Family Health Resources Flyer - Self-Funded Version
Fitness Reimbursement Flyer
Fitness Reimbursement Form
Flexible Spending Account (FSA) Claim Form
Flexible Spending Account (FSA) Election of Benefits Form
Flexible Spending Account (FSA) Employee Brochure
Flexible Spending Account (FSA) Employer Guide
Foodsmart^® Member Flyer
Foodsmart^® Employer Flyer
Foodsmart^® Telenutrition Member Flyer
Free Wellness Classes and Workshops
Free Virtual Fitness Classes
2022 Funding Account Changes Employer Broker Flyer
2022 Funding Account Changes Member Flyer
2022 Funding Account Options Flyer
Funding Accounts Employer Guide
Funding Account - Enrollment Roster
Funding Account Renewal Checklist - CDPHP
Group Authorization Agreement for Electronic Premium Deductions (EFT)
Health Funding Accounts Overview Flyer
Health Reimbursement Account (HRA) Employee Brochure
Health Reimbursement Account (HRA) Employer Guide
Health Reimbursement Account (HRA) Flexible Spending Account (FSA) Reporting Brochure
Health Resource Flyer - Self Funded
Health Tips For Men Flyer
HealthEquity Claims Integration Video
HealthEquity Comparison Chart
HealthEquity Health Savings Account (HSA) Eligibility Tip Sheet
HealthEquity Health Savings Account (HSA) Employer Instruction Flyer
HealthEquity Implementation Timeline
HealthEquity Member Education site
HealthEquity Reimbursement Account (RA) Implementation Checklist
HealthEquity Sales Resources
Healthy Direction Administration Agreement
Healthy Direction Employee How-to Flyer
Healthy Direction Employer Brochure
Healthy Direction: How to Report your Employer-Defined Activity
Healthy Direction Renewal Form
Hearing Health Discount Program
Hearing Health Copay Program
HMO Plan Network Overview Flyer
How We Coordinate Care
HRA Claim Form and Filing Instructions
HRA/FSA ACH Banking Authorizations
HRA/FSA Account Administrative Fees Flyer
HRA/FSA Administration Agreement - CDPHP
HRA/FSA Debit Card Request Form
iConnect login
Insights
Lactation Reimbursement Form
Lasik Claim Form
Logging Into Your Account: Your One Stop Shop
Maternal Reimbursement Form
Maternity and Family Benefits Guide
Member Value Brochure
2023 Group Medicare Employer Brochure
2023 Medicare Advantage Healthy Extras Brochure
2023 Medicare Group Disenrollment Form
2023 Medicare Group HMO & PPO Member Application
2023 Medicare Group Service Area Map
2023 Medicare Individual Broker Referral Form
2023 Medicare Large Group Creditable Coverage
2023 Medicare Small Group/Individual HD Creditable Coverage
Mental Health and Substance Use Flyer
Net Promoter Score
Over-The-Counter (OTC) Flyer
Ovia Health Employer Flyer
Ovia Health Member Flyer
PBM Changes Member Flyer
Pediatric Dental Group Attestation
Pediatric Member Dental Attestation
Personal Health Assessment (PHA) Flyer
Pharmacy Mail Order
Preferred Lab & Radiology
Prescription Reimbursement – Standard Claim Form
Preventative Care Guidelines Brochure - Adults
Preventive Drug List
Price Check Member Flyer
Price Check Commercial Employer Flyer
Qualified High Deductible Plans Flyer (Small Group only)
Reimbursement Account (RA) Renewal Checklist- HealthEquity
Rx for Less
Secure Site User Guide for Brokers
Self-Funded CDPHP Health Hub Member Flyer (powered by Virgin Pulse)
Shared Health Brochure (Large Group only)
Small Business Catalog Albany Region Q3 2022 | Q4 2022 | Q1 2023 | Q2 2023 | Q3 2023
Small Business Catalog Mid-Hudson Valley Region Q3 2022 | Q4 2022 | Q1 2023 | Q2 2023 | Q3 2023
Small Business Catalog Syracuse Region Q3 2022 | Q4 2022 | Q1 2023 | Q2 2023 | Q3 2023
Small Business Catalog Utica Region Q3 2022 | Q4 2022 | Q1 2023 | Q2 2023 | Q3 2023
Small Business Checklist
Small Business Renewal Brochure
Small Group/Individual High Deductible Creditable Coverage Analysis
Smoking Cessation Flyer for Families
Start or Renew Your Health Funding Account or Service
Take Control of Your Weight
Thousands of Doctors to Serve You
Triple Zero Plan Employer/Broker Flyer (Small Group only)
Virtual Health Care
Vision Hardware Reimbursement Form
VP Transform Prediabetes Member Flyer
VP Transform Prediabetes Employer/Broker Flyer
Weight Management Reimbursement Form
Wellness Resources Flyer
Workplace Health Brochure
Workplace Health Program Topics
Worksite Engagement Flyer (Small Group only)
Worksite Engagement Capital Region Flyer (Small Group only)

A-Z Forms

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