2021 Documents & Summaries
Alaska Chapter
Customer Service
Autumn Schwerdfager – Program 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
Submission Materials
- Submission Checklist
- Employer Application
- Employee Enrollment Form
- Enrollment Census Template
- Late Submission Letter
- EFT Authorization Form
- Vimly COBRA Administrative Agreement
Dental – Standard
Links, Forms & Helpful Information
Benefit Summaries
- $1,000 Annual Max
- $1,500 Annual Max
- $2,000 Annual Max
- $1,000 Annual Max with Orthodontia
- $1,500 Annual Max with Orthodontia
- $2,000 Annual Max with Orthodontia
Certificates
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
Certificates
Ancillary Benefits & Programs
Benefit & Program Summaries
- United Healthcare Life/AD&D Benefit Overview
- Life/AD&D Benefit Summaries:
- Life/AD&D Certificate (All Increments of Coverage)
- How to File a Life Claim