North Carolina Document Library

North Carolina and South Carolina Documents
Carolinas Broker Guide (PDF) Case Submission Checklist (PDF) HIPAA letter (PDF) HIPAA Authorization (for claims inquiries) (PDF) CAF (PDF) PAF (PDF) Compensation Form Instructions (PDF) 1099 Letter.pdf (PDF) Formulario de Inscripción / Cambio (Consolidado) (PDF)
North Carolina Documents
Group Enrollment Application (PDF) Risk Appraisal Questionnaire (PDF) HMO/POS Member Enrollment Application (PDF) Family Medical History Questionnaire (PDF) Supplemental Medical Questionnaire (PDF) North Carolina Medical Claim Form (PDF) Open Access Plus Enrollment/Change Form - English (PDF) Open Access Plus Enrollment/Change Form - Spanish (PDF)
North Carolina Benefit Summaries
Open Access CHMO Plan D (PDF) Open Access CHMO Plan E (PDF) Open Access CHMO Plan F (PDF) Open Access POS Plan G (PDF) Open Access POS Plan H (PDF) Open Access POS Plan I (PDF) Open Access POS Plan J (PDF) Open Access POS Plan K (PDF) Open Access POS Plan L (PDF) Open Access Plus Plan A (PDF) NC State Designed Basic CHMO Plan (PDF) NC State Designed Standard CHMO Plan (PDF) NC State Designed Basic Indemnity Plan (PDF) NC State Designed Standard Indemnity Plan (PDF) HDHP Plan 1: 90%/2000 (PDF) HDHP Plan 2: 90%2500 (PDF) HDHP Plan 3: 90%/3000 (PDF) HDHP Plan 4: 100%/3000 (PDF)