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J.Pappas University

J.Pappas Health

LARGE GROUP ACA

LIFE & DISABILITY

CONTACTS

PROVIDER

CARRIER LINK

FORMS

DENTAL & VISIONS

Small Group

HEALTH INSURANCE - SMALL GROUP

SMALL GROUP CENSUS FORM

ENROLLMENT FORMS

1. CERTIFICATION

2. EMPLOYER APPLICATION

3. EMPLOYEE ENROLLMENT

5. DENTAL APPLICATION

6. DENTAL SUMMARY OF COVERAGES

7. VISION APPLICATION

8. AUTOMATIC PAY PLAN

OTHER FORMS

CONVERSION FORM

HSA DECLARATION OF UNDERSTANDING

HSA SELECTION FORM

COBRA ELECTION FORM

HORIZON PROVIDER SEARCH

ENROLLMENT FORMS

1. CERTIFICATION

2. EMPLOYER APPLICATION

3. EMPLOYEE ENROLLMENT

5. DENTAL APPLICATION

6. AUTOMATIC PAY PLAN

OTHER FORMS

TERMINATION FORM

VERIFICATION - RENEWAL POLICY

DEBIT AUTHORIZATION

GROUP ENROLLMENT CHECKLIST

COBRA ELECTION FORM

OXFORD PROVIDER SEARCH

ENROLLMENT FORMS

1. CERTIFICATION

2. EMPLOYER APPLICATION

3. EMPLOYEE ENROLLMENT

5. COBRA ELECTION FORM

AMERIHEALTH PROVIDER SEARCH

ENROLLMENT FORMS

1. ENROLLMENT QUESTIONNAIRE

2. EMPLOYEE ENROLLMENT

4. CARVE OUT FORM

AETNA ADMIN PROVIDER SEARCH

CIGNA PHARMACY LIST

ENROLLMENT FORMS

1. EMPLOYER CERTIFICATION

2. EMPLOYER APPLICATION

2. EMPLOYER APPLICATION NY

3. EMPLOYEE ENROLLMENT NY

OTHER FORMS

PROOF OF ELIGIBILITY

AETNA AFA MEDICAL AND STOP LOSS APPLICATION

AFA ENROLLMENT FORM

COBRA ELECTION FORM

AETNA AFA PROVIDER SEARCH

HEALTH INSURANCE - LARGE GROUP MV/ACA COMPLIANT PLANS

Large Group

Minimum Essential Coverage Plan (MEC):

MEC Plan Options

MEC Plan Benefit Highlights

MEC Companion Card

Dental & Vision Plan:

Preventive & Comprehensive Dental Plan

Vision Plan Summary

MV Plan:

MV Plan Options

Group Application Form-MV

Administrative Services Agreement

Census Template-MV

Option Plus:

Employer Waiver Form

HEALTH INSURANCE - LEVEL FUNDED

Self Insured

AETNA AFA

SpringBoard Member Census Template (NJ and NY)
Cover Sheet Form (NJ and NY)
IMQ Enrollment Form (Short) (NJ AND NY)
Employee Enrollment Form
AHIA Data Software License Agreement
ACA Banking Consent Form (NJ and NY)

ALL STATE

INDIVIDUAL

Inividual

HORIZON

IND 2025 DENTAL AND VISION APPLICATION

IND 2025 DENTAL AND VISION BROCHURE

2025 IND MONTHLY PREMIUM RATES

2025 IND MEDICAL APPLICATION

2025 IND HEALTH BROCHURE

AUTOPAY

REQUEST FOR TERMINATION

HORIZON PROVIDER SEARCH

UNION

2026 ELITE UNION PLAN RATES & BENEFITS

2026 PREMIER UNION PLAN RATES & BENEFITS

HIP HMO PRIME LOW ENROLLMENT

EWA SOLSTICE ENROLLMENT KIT

CIGNA AND BLUE CARD ENROLLMENT FORM

PREMIER PLANS REFERENCE SHEET

HEALTH INSURANCE - MEDICARE

Medicare

AARP® Medicare Advantage from UHC NJ-0004 (PPO)

Summary of Benefits
Benefit Highlights
Enrollment
Provider Directory

AARP® Medicare Advantage from UHC NJ-0005 (PPO)

AARP® Medicare Advantage

from UHC NJ-6 (PPO)

AARP MEDICARE SUPPLEMENTAL UHC

AARP UHC Rx Saver PDP

AARP UHC Rx Preferred PDP

DENTAL & VISION

Dental & Visions

HORIZON - SMALL GROUP

DENTAL APPLICATION

DENTAL SUMMARY OF COVERAGES

VISION APPLICATION

HORIZON - INDIVIDUAL

IND 2024 DENTAL AND VISION APPLICATION

OXFORD

DENTAL APPLICATION

DELTA DENTAL

IND APPLICATION FORM

LIFE & DISABILITY & LONG TERM CARE

AMERICAN NATIONAL FULL APPLICATION

Some of our other insurance carriers include:

LONG TERM CARE INSURANCE QUOTE REQUEST FORM

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