2020 DOCUMENTS AND SUMMARIES
Washington 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
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
Links, Forms & Helpful Information
- UHC Website
- Welcome to myUHC Website
- UnitedHealthcare App
- EAP
- UHC Medical Claim Form
- Flu Shot Reimbursement Form
- OptumRx Mail-in Order Form
- OptumRx Reimbursement Form
- 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
- Premier 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
- Select Plus 500
- Select Plus 1000
- Select Plus 1500
- Select Plus 2000
- Select Plus 2500
Benefit Summaries
- Premier 250
- Premier 500
- Premier 1000
- Premier 1500
- Premier 2000
- Preferred 1000
- Preferred 2000
- Preferred 2500
- Preferred 3000
- Preferred 5000
- Premier 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
- Select Plus 500
- Select Plus 1000
- Select Plus 1500
- Select Plus 2000
- Select Plus 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
- My Smile 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: