ASSURANT
www.assuranthealth.com
www.assuranthealthsales.com (agent log in)
See INDIVIDUAL forms below
GROUP
Applications
Census (can be completed if OBES not available) 24311
Dental Only Employee Application 50400 8/07
Dental Only Employer Application 50300 9/07
Employee Application 50200 8/07
Employer Application/Participation Agreement 50100 8/07
HSA Tools Enrollment Form (UMB Bank) 2.10
HSA Tools Q & A 7.10
Real Choices Required Forms Grid 50545 7.10
Health Care Reform
Health Care Reform Group Overview 8.10
Grandfathered Small Group Plan 8.10
Timeline of Reform Changes 8.10
Manuals
Agent Guide 50502 9/09
Agent Guide Supplement 50511 11/07
Real Choice Agent Guide 1.10
Real Choice Employer Guide 50507 5.10
Tips for ER to talk to EE about HRAs 5.10
Misc Forms
Clear Choice vs. Real Choice Comparison 7.10
Dependent Verification 19201 10.05
Explanation of Benefits Disclosure Form 4.10
HRA TPA Brochure 4.09
POP FAQ 5.10
POP Highlight Sheet 5.10
Supplemental Participation Agreement 28817 6.10
Brochures & Flyers
Brochure - Ancillary 50506 5.10
Brochure - Real Choices HRA and HSA 50509 8.10
Brochure - HRA 28406 8.10
Brochure - HRA Q&A 8.10
Brochure - Supplement 50518 5.10
Brochure - Plan 1 50503 8.10
Brochure - Plan 2 50516 8/10
Brochure - Plan 3 50517 8/09
Brochure - POP 50514 5.10
Brochure - Real Choice Portfolio 50500 8.10
High Deductible Consumer Flyer 5.10
Real Choice Plans Flyer J68065 5.10
Small Group Plan Choice Flyer 50544 5.10
INDIVIDUAL FORMS
Applications
Application 4/10
Application Packet for Health Access 4/11
Preferred Rate Questionnaire 26566 6/06
Employer Sponsored Business Questionnaire 29174 10/05
HIPPA Eligibility From 25238 11/05
Dental
Dental Brochure Tri-Fold
Dental Application and Rates
Dental Vision Brochure 27653
Health Plans
Brochure - Assurant Health Access 4/2011
Health Access Plan B or C Client Tips Sheet 7/09
Brochure - CoreMed 29252 10/1/09
HSA
Addendum 29097 1/06
Adoption Agreement 28435 10/06
Brochure 29234 1/1/10
FAQ 28451 10/06
Plan Insert 28489 10/05
Q & A 28434 10/06
Manuals
Agent Guide 24357 9/10
Agent FAQ 43012 11/06
Ohio Variations 25140
UW & Administrative Guide 25472 8/10
UW Field Guide 07
Misc Forms
Credit Card 1st payment 29209
Credit Card Recurring 29208 1/06
Short Term
Short term application/rates/brochure 2/11
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