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
- SimpleCare Employee Enrollment Application
- SimpleCare Employee Enrollment Application with Medical
- Group Verification Form
- Member Accident Injury Form
- Group Admin Form
- Member Medical Claim Form (12-14-16)
- Other Insurance Questionnaire
- Authorization to Share Protected Health Information (PHI)
- Group & Individual Auto Pay Form (Spanish)
- Group 834 EDI Request Form
- SimpleCare Member Change Form
Documents
- Nurse Line Information
- Alliant Health Plans Covers Certain Preventive Care Services
- SimpleCare Certificates of Coverage
- SoloCare Certificates of Coverage
- 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
- Surprise Billing and Alliant Health Plans’ Response
Copyright 2016. Alliant Health Plans, Inc.
