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Independent health enrollment form

Independent health enrollment form 2025

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The document is an Enrollment Application/Change Form for Independent Health, designed for employees to apply for or modify their health insurance coverage. It includes sections for employer information, reasons for requests (such as adding or canceling coverage), employee and dependent information, prior health insurance details, provider selection, and certification of consent. The form also outlines the process for selecting reimbursement accounts like Flexible Spending Accounts (FSA) and Health Reimbursement Arrangements (HRA), along with necessary signatures and acknowledgments.

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Versions	Form popularity	Fillable & printable
2011	4.8 Satisfied (207 Votes)

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How to check balance on Independent Health extras card?

Log in to your member account to track your balance, view transactions, see how many days are left to spend remaining dollars, and more!

What are the Independent Health nutrition rewards?

Your reward benefit level depends on the type of health plan you signed up for. An individual plan member can earn up to $500 annually. An Individual and Child(ren) plan, Individual and Spouse plan, and Family plan can earn up to $1,000 annually. $2 in fresh produce must be purchased in a single transaction.

What is a health enrollment form?

Enrollment forms record whether employees have enrolled in or waived group benefits. For instance, if you have more than 50 full-time employees, you will need this data to complete IRS forms 1094 and 1095, which record health care coverage.

Is First Choice independent health?

First Choice Healths PPO Network is the largest independent Preferred Provider Organization in the Northwestern U.S. with over 120,000 healthcare providers under contract.

Does Independent Health cover gym memberships?

Independent Health offers a variety of lifestyle plans: FlexFit: Our FlexFit products offer one plan with two options: family and active. These products offer a unique debit card that provides $250 to use toward services such as gym memberships, massage therapy, vitamins, and after-school programs.

What can you use the Health Equity card for?

HealthEquity Visa Health Account card You can also use your HealthEquity debit card to make payments to your providers. This is especially convenient at the pharmacy. Most providers will also accept the card over the phone, online or written-in on the statement for payment.

What is an independent health association?

Independent Health Association (IHA) has provided healthcare coverage for communities in western New York for over 40 years. IHA focuses on providing affordable access to health-related products and services.

What can you use an independent health extras card for?

Health Extras Get a $250 debit card to use on fitness club memberships, massage therapy, vitamins and more.

Independent health enrollment form 2025

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