Broker Forms
REGISTRATION FORMS
- Agent Commission Agreement
- Broker Registration Form
- Commercial Underwriting Guidelines
- Notice of Privacy Practices
- W-9
ONLINE ACCESS / DIRECT DEPOSIT
INDIVIDUAL ENROLLMENT FORMS
- ACCESS HEALTHPLEX INDIVIDUAL APPLICATION
- Enrollment Form For GCDIY3
- Select NY Individual Enrollment Form
GROUP PLAN ENROLLMENT FORMS
- Dentcare Group Application - New York
- Dentcare Group Application Spanish - NY
- HIC Group Application
- Healthplex Preferred Choice (H7) Group Application - New York
- IHS CapDent/CapDent Plus Group Application - New Jersey
CLAIM FORMS
GROUP PAYMENT
- Dentcare Group Payment Form
- Dentcare Group Payment Form Spanish
- Healthplex Group Payment Form
- IHS Group Payment Form
OTHER
- CAA COMPENSATION DISCLOSURE RESOURCE GUIDE
- Change Of Broker Letter
- Dependent Student Certification Form
- Flyer For Managed Care And Select
- Flyer For Managed Care And Select
- Group Transmittal Form (Add/Term Members)
- Managed Care Brochure
- National PPO Brochure
- National PPO Brochure
- Subscriber Change Form
GROUP CONTRACT
EXCHANGE FORMS
- Group/Shop Adult/Family Enrollment Form Dentcare
- Group/Shop Adult/Family Enrollment Form HIC
- Group/Shop Pediatric Enrollment Form Dentcare
- Group/Shop Pediatric Enrollment Form HIC
- Group/Shop Pediatric Enrollment Form HIC
- Individual Adult/Family Enrollment Form Dentcare
- Individual Adult/Family Enrollment Form HIC
- Individual Pediatric Enrollment Form Dentcare
- Individual Pediatric Enrollment Form HIC