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Welcome to AGC Health Benefit Trust
Alaska Chapter

Program Overview

Overview
Product Grid
Underwriting Guidelines
Member Contact Information
Vimly Administration Guide
Prior year summaries, forms, etc. available on request. 

Customer Service 
Autumn Schwerdfager – Senior Account Manager
cell: 503.462.4041
direct: 503.977.5704
fax: 360.735.3144
toll-free: 800.735.8325
e: service@agchealthplansnw.com

Quoting & Submission Materials

Quoting Materials

  • Quote Request Form
  • Census Template
  • Certificate of Revenue from Construction

Submission Materials

CDHP Administration

Dollar Bank

Medical/RX – United Healthcare

Certificates

  • Premier 500
  • Premier 750
  • Premier 1500
  • Premier 2500
  • Premier 3000
  • Preferred 750
  • Preferred 1250
  • Preferred 1500
  • Preferred 2000
  • Preferred 3000
  • Consumer 1000
  • Consumer 2000
  • HSA 1750
  • HSA 2500
  • HSA 3000

Vision – Standard

Links, Forms & Helpful Information

  • VSP Website
  • VSP Provider Lookup
  • VSP Out of Network Claim Form
  • Eye Med Out of Network Claim Form
  • Choice Balance Care – Generic Eye Care Claim Reimbursement Form

Benefit Summaries

  • VSP Choice $10/$25
  • VSP Choice $10/$0
  • Eye Med $10/$25

Certificates

Ancillary Benefits & Programs

Benefit & Program Summaries

Certificates

  • Voluntary Life Certificate
  • Voluntary Accident Certificate

Forms

  • Voluntary Life & Accident Enrollment Form
  • Life Beneficiary Form
  • Life Claim Form
  • AD&D Claim Form
  • Voluntary Accident Claim Form

Flyers & Resources

  • LifeBalance Flyer
  • LifeBalance Website
  • Health Advocate Flyer
  • Health Advocate Website

Compliance Resources

Resources

  • Summary Plan Description
  • Privacy Notice to Members
  • COBRA Initial Notice Template (BSI Administers)
  • COBRA Initial Notice Template (BSI Does Not Administer)
  • HIPAA Release Form
  • 2019 Medicare Part D – Creditable Coverage Notice

Medical Travel Reimbursement Benefit

Medical Travel Reimbursement Benefit Program