Welcome to AGC Health Benefit Trust
Washington Chapter
Program Overview
Overview
Product Grid
Underwriting Guidelines
Member Contact Information
Vimly Administration Guide
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
- SBC Acknowledgement Form
- Late Submission Letter
- EFT Authorization Form
- Vimly COBRA Administrative Agreement
Dollar Bank
CDHP Administration Forms available upon request to: flexspending@vimly.com
Medical/RX – United Healthcare
SBC’s
- Premier 250
- Premier 500
- Premier 1000
- Premier 1500
- Premier 2000
- Preferred 1000
- Preferred 2000
- Preferred 2500
- Preferred 3000
- Preferred 5000
- Primary Advantage 2000
- HSA 1500 – with Motion
- HSA 2000 – with Motion
- HSA 3500 – with Motion
- HSA 5000 – with Motion
- Navigate 500
- Navigate 1750
- Navigate 2500
- Navigate 3500
- Nexus ACO 500
- Nexus ACO 1000
- Nexus ACO 1500
- Nexus ACO 2000
- Nexus ACO 2500
Certificates of coverage available upon request to: service@agchealthplansnw.com
Benefit Summaries
- Premier 250
- Premier 500
- Premier 1000
- Premier 1500
- Premier 2000
- Preferred 1000
- Preferred 2000
- Preferred 2500
- Preferred 3000
- Preferred 5000
- Primary Advantage 2000
- HSA 1500 – with motion
- HSA 2000 – with motion
- HSA 3500 – with motion
- HSA 5000 – with motion
- Navigate 500
- Navigate 1750
- Navigate 2500
- Navigate 3500
- Nexus ACO 500
- Nexus ACO 1000
- Nexus ACO 1500
- Nexus ACO 2000
- Nexus ACO 2500
Certificates of coverage available upon request to: service@agchealthplansnw.com
Dental – Delta Dental
Links, Forms & Helpful Information
- Delta Dental Website
- Delta Dental Provider Lookup
- Dental Claim Form
- MySmile Flyer
- Power Your Smile Brochure
Benefit Summaries
Vision – Standard
Links, Forms & Helpful Information
Benefit Summaries
Certificates
Life AD&D & Ancillary Benefits
Benefit & Program Summaries
- United Healthcare Life/AD&D Benefit Summaries:
- United Healthcare Life/AD&D Forms & Documents:
- LifeBalance: