Allied Group Health Forms-Agent

American Alternative Insurance Corp.
Forms

Wellness Horizons^®Health Plans
Group Health Major Medical Plans Brochure
Cost Saver Brochure	Cost Saver PLUS Major Medical	CoreValue Brochure
Plan Disclosure (for all plans)
Agent Guide (for all plans)
Employer Application (for all plans)
CS Employee Application	Major Medical Employee Application
CoreValue Voluntary Supplement Benefits Enrollment
Employee/Dependent Waiver (for all plans)
PPO Network Availability
Health History Questionnaires (major med)
Employee Limited Benefits Acknowledgment	Employer Limited Benefits Acknowledgement
Integrated Rx Benefit Flyer

State Specific Group Health Forms
American Alternative Insurance Corporation

California Employee Health Application

Iowa Uniform Group Health Application *

Nebraska Uniform Group Health Application *

*Allied accepts this application, use is not required.

Formas en Español (Spanish Forms)

Aplicación Principal de Seguro Médico/Salud para Empleados
(Major Medical Employee Application)

Costo de ahorro de aplicación empleado
(Cost Saver Employee Application)

No Cobertura para Empleados y/o Dependientes
(Employee / Dependent Waiver)

Evidencia Médica De Asegurabilidad Y Solicitud Del Empleado
Sólo California(Health Employee Application - California)

State Availability
CA, CO, GA, IA, IL, IN, KS, MO, NE, NV, OH, OK, TN, and TX.
Please note: In CA, only Cost Saver, Cost Saver PLUS and
CoreValue are available.

Guarantee Trust Life Forms

Listed below are enrollment forms that should only be used for additions to existing GTL groups.

> Employee Medical Application
> Employee Medical Application (Texas Only)
> Allied Cost Saver Employee Enrollment Form
> Employee/Dependent Waiver

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Click here to learn more about Allied's group health plans.

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