Forms

The forms below were created in Adobe Acrobat .PDF.  If you have trouble reading or accessing the forms, you may need the latest version of Acrobat Reader, which Adobe provides for free.  Click on the button below if you need to download Acrobat Reader.

There are two ways to access the .pdf forms:

1. You can click on the link, which will open a new browser window.  If you have Acrobat Reader, the file will open within a browser window.
    

2. You can right-click on your mouse to bring up a menu of choices, and can select to download the file onto your computer network or hard drive.  (On Internet Explorer, choose "Save Target As".)

Click here for detailed instructions for Internet Explorer users.

Forms Currently Available:

Request for Quote - Group Health and Ancillary Benefits - This pdf file is specially designed so you can complete the form on your computer after downloading it to your desktop.  Instructions.

Authorization for Release of Information or Records (HIPAA) - This form is necessary to complete when requesting Benefit Choices, Inc. or another third party advocate intervene on your behalf to resolve a claims issue.   Many providers accept this official HIPAA form  for purposes of releasing information to third parties, but some providers may have their own release form.  This form is used by CareFirst Administrators and Blue Cross / Blue Shield.  Instructions for completion appear on the form.  Additional Information.

Authorization for Release of Information or Records (PHN) - This form is necessary to complete when requesting Benefit Choices, Inc. or another third party advocate intervene on your behalf to resolve a claims issue.   This form is used by PHN.  Instructions for completion appear on the form.  Additional information and notes can be found here.

Benefit Choices Profile - Some basic information on our company and services.

"Just Because" Brochure - One of our mailer/handouts to prospective customers.

© 2002 Benefit Choices Inc.