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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

Submission Materials

  • Submission Checklist
  • Employer Application
  • Employee Enrollment Form
  • Enrollment Census Template
  • SBC Acknowledgement Form
  • Late Submission Letter
  • EFT Authorization Form
  • Vimly COBRA Administrative Agreement

Dollar Bank

  • Overview
  • Policy
  • Application

CDHP Administration Forms available upon request to: flexspending@vimly.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