Benefit Information & Forms

 
 
 
 
 
 

Glossary of Health Coverage and Medical Terms

Glossary of Terms

Disclosures of Creditable Coverage

2018 Creditable Letter and Disclosure

2019 Benefit Highlight Sheets

1000 PPO Plan

1750 PPO Plan

2750 PPO Plan

3250 PPO Plan

3000 High Deductible Health Plan

5000 PPO Plan

Employee Assistance Program (EAP)

Delta Dental

Vision Plan Benefits

Summary Plan Descriptions (SPD)

 

1000 PPO Plan SPD with RX Copay Option

1000 PPO Plan SPD with RX Deductible Option

1750 PPO Plan SPD with RX Copay Option

1750 PPO Plan SPD with RX Deductible Option

2750 PPO Plan SPD with RX Copay Option

2750 PPO Plan SPD with RX Deductible Option

3250 PPO Plan SPD with RX Copay Option

3250 PPO Plan SPD with RX Deductible Option

3000 High Deductible Health Plan SPD

5000 PPO Plan SPD with RX Copay Option

5000 PPO Plan SPD with RX Deductible Option

 

Plan Comparison Summary

2019 Basic Plan Comparison

2019 Deluxe Plan Comparison

2019 Plan Updates

2019 Plan Updates

Broker/Agency Forms

Census Form

Waiver of Coverage

Group Quote Checklist

Idaho AGC Group Application

Sold Group Checklist

Medical and Prescription Drug Forms

Blue Cross of Idaho Claim Form

Prescription Drug Claim Form

Lincoln National Life, STD, and Accident Coverage

Enrollment Form

Optional Life Summary

Short Term Disability Summary

STD Buy-Up Rates - Class 1

STD Buy-Up Rates - Class 2

Term Life and AD&D Summary

Accident Summary

Employer Applications

Idaho AGC Health Plan Large Group Application

Lincoln Financial Life/STD Insurance Form

Employer Forms

Leave of Absence Request

Self-Termination of Employee or Dependent Form

Additional Discounts & Services

Blue Cross of Idaho

Blue Extras

Delta Dental

DDID Amplifon Hearing Aid 

Orthodontic Discount Providers

Mobile App 

VSP Member

VSP Exclusive Extras

BPA Health Employee Assistance Program (EAP)

EAP Video Counseling

Lincoln National

Travel Connect

LifeKeys

Employee Connect

 

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