Employer Forms and Documents
For your convenience, we have made the forms below fillable. To enable your computer to edit the forms, follow these instructions.
Forms
- SoloCare Individual Enrollment Application/Change in Coverage Form
- Small Group Employee Enrollment Application
- Small Group Employee Enrollment Application – Spanish Version
- Large Group Employee Enrollment Application
- Member Accident Injury Form
- Group Admin Form
- Member Medical Claim Form (12-14-16)
- Coordination of Benefits Questionnaire
- Authorization to Share Protected Health Information (PHI)
- Group & Individual Auto Pay Form (updated 8-14-2017)
- Group 834 EDI Request Form
Documents
- Alliant Health Plans Covers Certain Preventive Care Services
- SimpleCare Certificates of Coverage
- SoloCare Certificates of Coverage
- Member Handbook
- Important Contact Information
- Reporting Life Changes to Healthcare.gov
- Alliant ID Card Mobile App Instruction Guide
- Alliant Network Provider Search Instructions
- Procedures Requiring Prior Authorization
Copyright 2016. Alliant Health Plans, Inc.