Forms and Links

Note to Participating Members: All AMHIC groups do not offer all AMHIC plans. Please check with your human resources department to confirm which AMHIC plans are offered by your employer.

Member Resources:

• Member Resources Contact Guide

Forms:

Medical (PPO, Network Only & Kaiser)
• Enrollment Form
• Express Scripts Prescription Drug Claim Form
• Express Scripts Mail Order Form
• PPO Medical Claim Form
• NCAS Student Certification Form

Dental
• Dental Claim Form
• Enrollment Form
• Dental Generic ID Card

Legal
• 2010 Legal Resources Enrollment Form
• Legal Resources Plan Attorneys
• Enrollment Form

Life
• Life Insurance - Beneficiary
• Life Insurance - Conversion Policy
• Life Insurance - Enrollment
• Life Insurance - Statement of Health

Flexible Spending Account

• FSA Enrollment Form
  
• How to File a Claim
  
• FSA Claim Submission Form
  
• FSA Dependent Care Claim Form


Vision
• Vision Claim Form
• Enrollment Form
• Vision ID Reference Card

Domestic Partners
• Domestic Partner Policy & Forms

General Information
• Wells Fargo Transmittal Form
• Life Insurance - Employer Instructions for Filing Group Life Insurance Claims
• Life Insurance - Yearly Salary Change Form

Links:

• Medical (PPO, Network Only Plans)
    • Network Directories:
      » CareFirst Network - Choose either the Preferred Provider Organization (PPO)
         or Preferred Provider Network (PPN).If you choose the Preferred Provider        Organization option DO NOT use the National BCBS Directory.
      » PHCS Network
      » OneNet PPO
      » NCPPO Network
    • Express Scripts Prescription Drugs
    • Health Advocate
    • NCAS
    • NCAS Internet Self-Service (User ID & Password Needed)
  
  Dental
    • MetLife
  
  Flexible Spending Account
    • Connect Your Care
  
  Life Insurance
    • MetLife
  
  Legal
    • Legal Resources
    • Resources National Plan
  
  Vision
    • United HealthCare Vision
  
  Employee Assistance Program - Enter Company Code "AMHIC"
    • APS Healthcare
  
  

Kaiser Permanente Select HMO
  • Kaiser Permanente