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Broker Links

Documents and Forms

 

 

 

 

General Information

 

2011-12 Underwriting Guidelines

Plan Comparison

BSI Reference Guide

PHT Broker Administrative Guide


Renewal  Booklet

 

Contact our broker relations department to discuss becoming an appointed selling agent. 
(971) 255-5359 or quotes@pacifichealthtrust.com

 

RFP Forms

 

Quote Request Form

Electronic Census

Group Health Risk Questionnaire

Individual Health Statements

 

New Group Forms

 

New Group Checklist

New Group Master Application

EFT Form

PHT Joinder Agreement (Indenture)

Employee Enrollment Form

Late Submission Application/Letter (Required if submitted after the 20th)

HN Ongoing Care Form (Optional)

HN Waiver Form (Optional)


BSI COBRA Administrative Agreement (if Applicable)

BSI CDHP Cafeteria Plan Adoption Form (If Applicable)

BSI CDHP Group Enrollment Forms (If Applicable)

BSI CDHP Employee Enrollment Form (if Applicable)


Renewal Forms

 

 

 

 

 

Renewal Application




 

2010 Pacific Health Trust