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CBSA Forms and Supplies available for download:

Fully Insured Marketing materials Fully Insured Enrollment Forms CBSA overview(Why CBSA?) Product overview brochure(2-99) except AZ Product overview brochure(2-99) AZ CBSA HealthEdge brochure Plan Highlights CBSA HealthEdge CBSA HealthEssentials brochure Plan Highlights HealthEssentials HealthDirect HSA ER product brochure HealthDirect HSA EE product brochure HealthDirect HSA broker sales tips HealthDirect HSA Specifications Sheet Fully Insured Carrier Chart Supply Request Form (#00048-0306) Fully Insured HealthDirect HSA U.S. Bank Materials Client Profile Questionnaire Broker brochure Employer brochure Employee Enrollment Kit and Fee Schedule Employee Welcome Kit Sample Producers Presentation to Employees Producers Presentation to Employers HSA Health Direct Implementation Guide HSA Producer Quick Tips Miscellaneous Materials COBRA Information LabOne: The Benefit LabOne: Q & A Member Guide Fully Insured State Mandates AR, AZ, GA, IA, ID, IL, IN, KS, LA, MI, MO, MS, MT, NC, ND, NE, NM, NV, OH, OK, SC, SD, TN, TX, UT, WI, WY Security Life Landmark Dental Plan Landmark Dental Enrollment Applications Employer Applications AR, AZ, GA, IA, ID, IL, IN, KS, LA (Life), LA (Medical), MI, MO, MS, MT, NC, ND, NE, NM, NV, OH, OK, SC, SD, TN, TX, UT, WI, WY Employee Applications AR, AZ, GA, IA, ID(2-50), ID(51+), IL, IN, KS, LA (Life), LA (Medical), MI, MO, MS, MT, NC, ND, NE, NM, NV, OH, OK, SC, SD, TN, TX, UT, WI(2-50), WI(51+), WY Medicare Part D CMS Medicare Part D creditable coverage sample notice CMS Medicare Part D non-creditable coverage sample notice Security Life Apex Dental Plans Apex Group brochure/Application Apex Personal (1-Life) brochures/Application Dental Enrollment Procedures Group Underwriting Guidelines Personal (1-Life) Underwriting Guidelines Broker Appointment Instructions/Forms Previously Appointed Instructions/Forms Apex Dental PPO Network/PPO USA Network AccuRate Software Installation Installation Instructions Premium Only Plan POP Insert POP Marketing brochure POP Employer Application POP Employee Election Form Underwriting Forms Group Prescreen Form Group Underwriting Guide Group Transmittal Enrollment Procedures Waiver of Insurance Form Employer Certification for 1099s Translator Statement Common Ownership Form Request for Spouse 24 Hour Coverage 24 Hour Coverage Guidelines 24 Hour Coverage Guideline (AZ) 24 Hour Coverage Guideline (IA) 24 Hour Coverage Guideline (NC) 24 Hour Coverage Guideline (TX) On-The-Job Medical Coverage Guidelines (NV) Arthritis Questionnaire Asthma Questionnaire Back/Spinal Condition Questionnaire Common Law Marriage Questionnaire Generic Questionnaire Cancer Questionnaire Coronary Artery Disease Questionnaire Diabetes Questionnaire Fibromyalgia Questionnaire Hepatitis Questionnaire High Blood Pressure Questionnaire Pregnancy Questionnaire Psychiatric/Mental/Nervous Questionnaire Seizure Questionnaire Substance Abuse Questionnaire Administration Forms Bank-O-Matic Form Beneficiary Change Form Direct Commission Deposit Form Other Insurance Coverage Form Report of Changes Form Section 125 / Flexible Benefits FSA (Flex) Employee Brochure Flex Claim Form Dependent/Child Care Receipt Orthodontia Receipt Flex Change of Status Form Direct Deposit - Employee Direct Deposit - Employer FSA guidelines for over-the-counter medications and supplies Connections Newsletter FSA 12/05 Updated Web site - FSA employee overview brochure Small Group Self Funded Materials - ESP CBSA and ESP Overview  (00050-0405) Broker Brochure  (00065-0505) Employer Brochure  (00049-0405) Request for Proposal Checklist  (02100306-0605) Sample Proposal  (7/26/2005) New Case Checklist for Brokers  (00044-0305) Employer Information Form  (05090204-0410) Employee Enrollment Form  (05110208-0411) Management Reports  (05080305-0311DETAIL) Self Funded Enrollment Forms CBSA Overview Brochure PPO network discounts HIPAA portability requirements sample notice Connections Newsletter 9/05 Connections Newsletter 10/05 Connections Newsletter 12/05 Connections Newsletter 5/06 Connections Newsletter 7/06 CMS Medicare Part D creditable coverage sample notice CMS Medicare Part D non-creditable coverage sample notice Managed Care 2000+ is now Guided2Healthsm Sample employee notice: Managed Care 2000+ is now Guided2Healthsm Member overview brochure Member overview brochure with NurseLine HIPAA Compliance Services HIPAA Compliance Services Brochure

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