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  • Payment Authorization Form For All Savers Alternate Funding

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Payment Authorization Form for All Savers Alternate Funding A. APPLICANT INFORMATION Employer NameB. INITIAL METHOD OF PAYMENT Check Enclosed Electronic Fund Transfer (EFT) (Complete EFT Authorization.

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With All Savers Alternate Funding, if the covered health care claims are lower than expected, your plan shares the savings with money back at the end of the year (where allowed by state law). And if the covered claims are higher than expected, your stop-loss insurance policy covers them.

Prior Authorization is required.

All Savers Alternate Funding is a self-funded health plan designed specifically for small businesses. It includes 3 parts: 1 . Your self-funded medical plan, which pays covered medical expenses of your covered employees and their dependents.

For mental health referrals, please call the number on the back of the member's ID card or call 800-291-2634. Electronic: For claims submitted electronically, please use payer ID 81400.

Excess Loss insurance coverage is provided by All Savers Insurance Company, a UnitedHealthcare company.

Like many insurance companies, All Savers Insurance Company's product offerings include PPO and EPO plans.

Paper Claims Submission: Mail to the address listed on the back of the member's ID Card. Where to go: Online: uhcprovider.com/priorauth and select the specialty you need. Benefit Information: Call the number on the back of the member's ID Card.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232