AH001
|
Group Health Product Requirements Checklist
|
PDF |
English |
AH002
|
Group Health Large and Small Employer Requirements Checklist
|
PDF |
English |
AH003
|
Group Health Non-Employer or Member Association Checklist
|
PDF |
English |
AH004
|
Group Health Accident Only/Accidental Death and Dismemberment (AD&D) Checklist
|
PDF |
English |
AH005
|
Group Health Discretionary Group Checklist
|
PDF |
English |
AH008
|
Group Health Employer Market Form Filing Checklist - Figure 40, 42, 47, 48, and 50
|
PDF |
English |
AH009
|
Group Health Specified Disease Checklist
|
PDF |
English |
AH010
|
Group Health Stop Loss Checklist
|
PDF |
English |
AH011
|
Group and Individual Dental and Vision Checklist
|
PDF |
English |
AH012
|
Group and Individual Long-Term Care Checklist
|
PDF |
English |
AH013
|
Group and Individual Health Supplemental Coverage Checklist
|
PDF |
English |
AH014
|
Group and Individual Health Medicare Supplement and Select Checklist
|
PDF |
English |
AH015
|
Individual Health Product Requirements Checklist
|
PDF |
English |
AH016
|
Individual Health Major Medical Checklist
|
PDF |
English |
AH017
|
Individual Health Limited Benefit Checklist
|
PDF |
English |
AH018
|
Individual Health Accident Only / Accidental Death and Dismemberment (AD&D) Checklist
|
PDF |
English |
AH020
|
Individual Health First Diagnosis or Critical Illness and Specified Disease Checklist
|
PDF |
English |
AH021
|
Individual Health Rate / Rate Increase Filing Requirements Checklist
|
PDF |
English |
AH022
|
Individual and Group Health Disability Income Protection Checklist
|
PDF |
English |
AH023
|
Individual and Group Health Hospital Indemnity Checklist
|
PDF |
English |
AH024
|
Individual Short-Term Recovery Care Checklist
|
PDF |
English |
AH025 (Fillable PDF)
|
Balance billing waiver
Fillable PDF version
|
PDF |
English |
AH025
|
Balance billing waiver
|
PDF |
English |
LAHR330
|
Small Employer Carrier Status Certification
|
PDF |
English |
LAHR334
|
Form Number 1212 Cert Actuarial Annual Small Employer Health Benefit Plan Actuarial Certification - Figure 47
|
PDF |
English |
LAHR335
|
Form Number 1212 CERT DATA Annual Small Employer Health Benefit Plan Report
|
PDF |
English |
LAHR337
|
Large Employer Carrier Status Certification
|
PDF |
English |
LHL610
|
Consumer Choice Health Benefit Plans Data Certification
|
PDF |
English |