Funding Advantage Resources & Forms

Allied National works hard to provide you with the resources you need to explain and sell Funding Advantage to your clients. View the sections below to quickly find the forms and resources you need to access and download.

State Availability

State Product Availability Map

Funding Advantage Marketing Materials

Click on the button below to go to the section you need or feel free to scroll through the list.

Sales & Promotional

Spanish Forms & Flyers

Video

Enrollment

Agent Training

Miscellaneous Underwriting Forms

Additional Resources

Sales & Promotional

Materials you need to sell a Funding Advantage case.

Funding Advantage Brochure

Detailed explanation of Funding Advantage, a level-funded plan featuring stop-loss insurance.

Funding Advantage
Employer Guide

Allied National
Guide to Level Funding

Cost Saver Sales Brochure

This employer guide will help employers understand and administer their group health coverage.

Benefit consultant's and employer's guide to level-funded health plan administration and stop-loss insurance.

Detailed explanation of Cost Saver, our Funding Advantage level-funded, limited benefit group health plan, that features no medical underwriting.

MEC Brochure

MEC Flyer

PPO Network Availability

This Minimum Essential Coverage (MEC) Brochure can be personalized by an agent.

This Minimum Essential Coverage (MEC) Flyer can be personalized by an agent.

Chart showing the available PPOs in each applicable state.

Sample Proposal

Sample group health benefit plan proposal for Funding Advantage.

Sales Transmittal Form

This form must be filled out by the agent or broker and sent in with each case submitted to Allied National.

MEC Benefits Description Sheet

Benefits description sheet that lists the Preventive Minimum Essential Coverage (MEC) plan benefits for health services for adults, women and children.

HealthChoices Flyer

HealthChoices Flowchart

HealthChoices is an optional benefit under the Funding Advantage health plan. This flyer explains the benefit to members.

This HealthChoices chart shows the additional benefits and potential benefit reductions for non-compliance for those covered under the HealthChoices Option.

Benefit Grid

This list shows the basic benefits and combinations available with the Funding Advantage plan.

Animated Videos

Freedom Plan

Funding Advantage

Allied HealthCare Assistant

Direct Primary Care

Cost Saver

Telehealth

HealthChoices

Our Allied National Freedom Plan puts control back into the hands of the consumer. We use reference-based pricing, the alternative to PPO pricing, that uses Medicare as a reference point to help determine how much to pay your provider.

A plan for employers with two or more employees with a good health experience who feel they are paying too much premium for too little in benefits.

A suite of services created to ensure our members have the absolute best access to the best health care.

Allied can help small employers combine Direct Primary Care coverage with comprehensive major medical protection.

A unique, low-cost group health plan for employers who are priced out of the cost of traditional major medical coverage.

How to use a smartphone or personal computer to get immediate health care.

The HealthChoices benefit option provides Funding Advantage members with an immediate monthly premium discount.

Enrollment

Materials you need to enroll a Funding Advantage case.

Plan Sponsor Statement 2-14
(Employer Form)

Employee Med Enrollment Form

Agreement form for employers with 2-14 employees to sign indicating willingness to fund a health benefit plan for the company's employees.

Use this medical enrollment form for all major medical groups.

15+ Plan sponsor statement including employer disclosure statement

Non-Medical Plan Employee Enrollment Form (for use with MEC, Cost Saver)

Agreement form for employers with 15+ employees to sign indicating willingness to fund a health benefit plan for the company's employees.

This is the non-medical enrollment form for employees enrolling in the Preventive Minimum Essential Coverage (MEC) and Cost Saver ONLY.

Allied National Enrollment

Call us at 888-767-7133 or email [email protected]

We also accept these online enrollment applications:

FormFire
EasyAppsOnline
eHealthApp
EaseCentral

Employee/Dependent Waiver (used for all Allied health plans)

Employee Enrollment Recertification

Health History Questionnaires

Used by employees opting out of coverage for themselves or dependents.

Use this form to re-certify "stale" dated enrollment forms.

Use this questionnaire to gather information about an employee's health history.

Online Group Enrollment System User Guide for Agents and Employers

User guide for agents and employers to enroll easily online. Follow the steps to completing health plan enrollment forms for both initial enrollment and plan add-ons.

Sales Transmittal Form

This form must be filled out by the agent or broker and sent in with each case submitted to Allied National.

Freedom Plan Disclosure

Hybrid Freedom Plan Disclosure

Detailed information about our Freedom Plan options and an agreement for employers who have chosen to use the plan.

Detailed information about our Freedom Hybrid Plan options and an agreement for employers who have chosen to use the plan.

Group Census for New Business

Download this spreadsheet to collect a census for new groups.

Miscellaneous Underwriting Forms

Affidavit - Participating Business Owner

Affidavit - Eligible Independent Contractor

A participating business owner must use this affidavit to certify eligibility to participate in the plan on the same basis as an eligible employee.

Allows eligible independent contractors to participate in the Plan Sponsor's group health plan on the same basis as a full-time employee.

Affidavit - Committed Domestic Relationship

ERISA Enrollment Employee Statement

Use this to certify that an employee’s partner is eligible to participate in the health plan as a dependent spouse.

The form an employee fills out to show their interest in being enrolled in the company's group health benefit plan.

Release of Health Information

A member signs this form to authorize Allied National to have access to their health documents.

Payment Authorization

This form authorizes Allied National to subtract payments from an employer's checking account.

MEC/Cost Saver Employee Spreadsheet Enrollment Worksheet

Employers need to fill out this spreadsheet listing each employee who is electing coverage.

Spanish Forms and Flyers

Formulario De Inscripción Para El Plan De Salud Autofinanciado Por El Empleado
(Employee Enrollment Card)

Spanish version of a form that each employee needs to fill out and sign; will be turned in to Allied National by the Agent, along with the signed Plan Sponsor Statement.

Para el plan de cobertura esencial mínima SOLAMENTE (Employee PMEC
Non-Medical Enrollment Card)

Spanish version of the non-medical enrollment form for employees enrolling in the Preventive Minimum Essential Coverage (PMEC) and Cost Saver ONLY.

Los Servicios Preventivos (PMEC Benefits Description Sheet)

Spanish version of the Preventive Minimum Essential Coverage (PMEC) Benefits.

Para Inscripciones Medicas D 50+ Solamente (Employee 50+ Enrollment Card)

Spanish version of the Employee 50+ Enrollment Card.

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

Spanish version of Employee/Dependent Waiver used by employees opting out of coverage for themselves or dependents.

Usted tiene la cobertura Premium Advantage PPO
(PPO Network Flyer)

Spanish version of the PPO Network Flyer.

Preventivo Plan de cobertura esencial mínima (PMEC ID Card Kit)

Spanish version of the MEC ID Card Kit.

Recertificación de inscripción de Allied National (Employee Enrollment Recertification)

Spanish version of the Employee Enrollment Recertification.