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:
- Small Group Employee Enrollment Application
- Member Accident Injury Form
- Group Admin Form (updated 10-16-2015)
- Member Medical Claim Form (12-14-16)
- Coordination of Benefits Questionnaire
- Authorization to Share Protected Health Information (PHI)
- Group & Individual Auto Pay Form (updated 5-23-2017)
- 2017 SoloCare Brochure
- 2017 SimpleCare Brochure
Documents:
- 2017 SoloCare Certificate of Coverage
- 2016 SimpleCare Certificate of Coverage
- 2017 SimpleCare Certificate of Coverage
- Member Handbook
- Helpful Member Information (7-29-2015)
- Reporting Life Changes to Healthcare.gov
- Alliant ID Card Mobile App Instruction Guide
- Provider Search Instructions
- Procedures Requiring Prior Authorization
- Alliant Health Plans Covers Certain Preventive Care Services
Copyright 2016. Alliant Health Plans, Inc.