agc-wa-ak-small

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

Medical/RX – United Healthcare

Links, Forms & Helpful Information

  • UHC Website
  • Welcome to myUHC Website
  • Health4Me Flyer
  • EAP/Care 24
  • UHC Medical Claim Form
  • Flu Shot Reimbursement Form
  • OptumRx Mail-in Order Form
  • OptumRx Reimbursement Form
  • Navigate Overview
  • Navigate FAQ’s
  • Navigate-Choosing a Primary Care Physician

SBC’s

  • Premier 250
  • Premier 500
  • Premier 1000
  • Premier 1500
  • Premier 2000
  • Preferred 1000
  • Preferred 2000
  • Preferred 2500
  • Preferred 3000
  • Preferred 5000
  • HSA 1500
  • HSA 2000 Custom (with motion)
  • HSA 3500
  • HSA 5000 Custom (with motion)
  • Primary Advantage 2000
  • Charter 3500
  • Navigate 500
  • Navigate 1750
  • Navigate 2500
  • Navigate 3500

Benefit Summaries

  • Premier 250
  • Premier 500
  • Premier 1000
  • Premier 1500
  • Premier 2000
  • Preferred 1000
  • Preferred 2000
  • Preferred 2500
  • Preferred 3000
  • Preferred 5000
  • HSA 1500
  • HSA 2000 Custom (with motion)
  • HSA 3500
  • HSA 5000 Custom (with motion)
  • Primary Advantage 2000
  • Charter 3500
  • Navigate 500
  • Navigate 1750
  • Navigate 2500
  • Navigate 3500
  • Rx Plan 451 -$15/$40/$70/$250
  • Rx Plan 495 – $15/$45/$85/20%

Certificates of coverage available upon request to: service@agchealthplansnw.com

Life AD&D & Ancillary Benefits

Benefit & Program Summaries

Compliance Resources

Resources

  • Summary Plan Description
  • Privacy Notice to Members
  • COBRA Initial Notice Template (Vimly Administers)
  • COBRA Initial Notice Template (Vimly does not Administer)
  • HIPPA Release Form
  • 2020 Medicare Part D – Creditable Coverage Notice
  • 2020 Medicare Part D – Non-Creditable Coverage Notice