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.

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

Legal
• 2009 Legal Resources Enrollment Form
• 2008 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

2008 Flexible Spending Account
• Flexible Spending - Automatic Dependent Care
• Flexible Spending - Dependent Care Worksheet
• Flexible Spending - Reimbursement Voucher
• Annual Flexible Spending Account Election Form

2009 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
• Transmittal (For Benefit Managers Only)
• Supply Form (For Benefit Managers Only)
• 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 - Select Preferred Provider Organization (PPN/PPO) and then
         select either Maryland PPN/PPO or DC - Blue Preferred/Select PPO(even if you       are not in the AMHIC PPO plan, this is the option you choose, you have access       to providers from both, no matter where you live)
      » PHCS Network - Select green PHCS logo
      » OneNet PPO (formerly Alliance)
      » NCPPO Network
    • Express Scripts Prescription Drugs
    • Health Advocate
    • NCAS
    • 2009 NCAS Internet Self-Service (User ID & Password Needed)
    • 2008 NCAS Internet Self-Service (User ID & Password Needed)
  
  Dental
    • MetLife
  
  Flexible Spending Account (2009)
    • Connect Your Care
  
  Life Insurance
    • MetLife
  
  Legal
    • Legal Resources
    • Resources National Plan
  
  Vision
    • United HealthCare Vision (formerly Spectra)
  
  Employee Assistance Program - Enter Company Code "AMHIC"
    • APS Healthcare
  
  

Kaiser Permanente Select HMO
  • Kaiser Permanente