PROPERTY & CASUALTY

forms

COMMERCIAL PROPERTY AND LIABILITY

APP - RESTAURANT

45 ADITIONAL INTEREST

125 APPLICANT

126 GENERAL LIABILITY

139 STATEMENT OF VALUES

140 PROPERTY

141 CRIME

160 BOP

185 RESTAURANT SUPPLEMENT

ASSAULT AND BATTERY EXCLUSION

WORKERS COMP

130 WORKERS COMP

CERTIFICATE OF NY'S WORKERS COMPENSATION INSURANCE COVERAGE

NY POSTING NOTICE

OFFICER WAIVER C105.51

UMBRELLA

83 PERSONAL UMBRELLA

131 UMBRELLA

SURETY

SURETY CNA

FLOOD

29 FLOOD

TERRORISM

SUPPORT / SERVICE

Anchor 3

ENDORSEMENT

ANTI-DISCRIMINATION AND ANTI-HARASSMENT GUIDE

CERTIFICATES

25 GENERAL LIABILITY CERT

27 HOME CERT

28 ACCORD 10-03

28 COMMERCIAL PROPERTY CERT

ACCORD 27 PROPERTY

A-II MORSTAN FORM

NYS C105.2

SERVICE

35 ACORD POLICY RELEASE

36 ACORD FORM BROKER RECORD OF CHANGE

37 NO LOSS LETTER

LOSS RUN REQUEST

BROKER OF RECORD FORM

HEALTH INSURANCE - SMALL GROUP

Anchor 2

SMALL GROUP CENSUS FORM

DOL PENALTIES

ENROLLMENT FORMS

1. CERTIFICATION

2. EMPLOYER APPLICATION

3. EMPLOYEE ENROLLMENT

4. WAIVER

5. DENTAL APPLICATION

OTHER FORMS

TERMINATION FORM

VERIFICATION - RENEWAL POLICY

DEBIT AUTHORIZATION

GROUP ENROLLMENT CHECKLIST

OXFORD BOR

MORE FORMS

COBRA ELECTION FORM

OXFORD PROVIDER SEARCH

ENROLLMENT FORMS

1. CERTIFICATION

2. EMPLOYER APPLICATION

3. EMPLOYEE ENROLLMENT

4. WAIVER

5. DENTAL APPLICATION

6. DENTAL SUMMARY OF COVERAGES

7. VISION APPLICATION

OTHER FORMS

CONVERSION FORM

HSA DECLARATION OF UNDERSTANDING

HSA SELECTION FORM

HEALTH BOR

COBRA ELECTION FORM

HORIZON PROVIDER SEARCH

ENROLLMENT FORMS

1. CERTIFICATION

2. EMPLOYER APPLICATION

3. EMPLOYEE ENROLLMENT

4. WAIVER

5. COBRA ELECTION FORM

AMERIHEALTH PROVIDER SEARCH

ENROLLMENT FORMS

1. ENROLLMENT QUESTIONNAIRE

2. EMPLOYEE ENROLLMENT

3. WAIVER

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

ACH FORM

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

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

ACH Form- MV

Administrative Services Agreement

Census Template-MV

W9- Form

Auto Pay Form

HEALTH INSURANCE - INDIVIDUAL

AARP ADVANTAGE PPO:

AARP Medicare Advantage PPO

AARP Advantage PPO Enrollment

AARP Medicare Advantage HMO-POS

AARP PDP:

AARP PDP Summary of Benefits

AARP PDP Enrollment Form

AARP SUPPLEMENTAL:

AARP Benefit Summary Plan G

AARP Supplemental Guide

AARP Guide to Supplemental Insurance

AARP Supplemental Change Form

AARP 2023-2024 Medicare Supplemental Rates

AARP 2023-2024 Medicare Supplemental Enrollment Kit

AARP 2023-2024 Medicare Supplemental Enrollment Kit- no wellness

INDIVIDUAL FORMS

IND 2024 DENTAL AND VISION APPLICATION

IND 2024 DENTAL AND VISION BROCHURE

2024 IND MONTHLY PREMIUM RATES

2024 IND MEDICAL APPLICATION

2024 IND HEALTH BROCHURE

AUTOPAY

REQUEST FOR TERMINATION

HORIZON PROVIDER SEARCH

HEALTH INSURANCE - UNION

2022 UNION PLAN RATES & BENEFITS

HIP HMO PRIME LOW ENROLLMENT

CIGNA AND BLUE CARD ENROLLMENT FORM

EWA SOLSTICE ENROLLMENT KIT

UNDERWRITING

PREMIER PLANS REFERENCE SHEET

LIFE AND LONG TERM INSURANCE

AMERICAN NATIONAL FULL APPLICATION

Some of our other insurance carriers include:

LONG TERM CARE INSURANCE QUOTE REQUEST FORM

J.Pappas Payments

JPAPPAS.COM

PROPERTY & CASUALTY

2022 UNION PLAN RATES & BENEFITS

EWA SOLSTICE ENROLLMENT KIT