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)
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) Enrollment/Change Form - English (PDF) Formulario de Inscripción / Cambio (Consolidado) (PDF)
North Carolina Benefit Summaries - January 2010
State Designed Basic HMO (PDF) State Designed Standard HMO (PDF) State Designed Basic Indemnity (PDF) State Designed Standard Indemnity (PDF)
North Carolina Benefit Summaries - No longer Available January 1, 2010
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)