Allied Group Health Forms-Agent

American Alternative Insurance Corp.
Forms

Allied™ Cost Saver	Allied™ Cost Saver PLUS Major Medical	Wellness Horizons^® Major Medical Plans
Group Health Plans Brochure (for all plans)
Cost Saver and Cost Saver PLUS Brochure
Plan Disclosure (for all plans)
Agent Guide (for all plans)
Employer Application (for all plans)
CS Employee Application	Major Medical Employee Application
Employee/Dependent Waiver (for all plans)
PPO Network Availability
Employee Limited Benefits Acknowledgment	Health History Questionnaires (major med)
Employer Limited Benefits Acknowledgement		Allied™ HSA TurnKey Solution forms
Cost Saver California Rate Chart	Cost Saver PLUS Major Medical California Rate Chart
		Integrated Rx Benefit Flyer

State Specific Group Health Forms
American Alternative Insurance Corporation

California Employee Health Application

Iowa Uniform Group Health Application *

*Allied accepts the Iowa Uniform Group Health 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, PA, TN, and TX. Please note: In CA, only Cost Saver and Cost Saver PLUS are available. In CO, only Cost Saver is 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.