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Get Cobra/alternative Coverage Form (see ... - Selecthealth - Selecthealth

Med PlusSM q Select ChoiceSM* q Select ValueSM * Benefits are administered by SelectHealth, Inc. and underwritten (insured) by SelectHealth q Select Choice PremierSM* q SelectHealth EyewearSM q SelectHealth DentalSM Benefit Assurance Company, Inc. A. EMPLOYEE INFORMATION (Qualified Beneficiary) Qualified Beneficiary (QB) q I would like to enroll in COBRA or; q I would like to enroll in 12 months of alternative coverage (NetCare) and waive my COBRA rights. NetCare Deductible Opt.

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Get a Form 1095-B from Select Health Log in to your Select Health account and download your 1095-B under "Documents" Send an email to premiums@selecthealth.org to request your 1095-B. ... Call our Billing team at 844-442-4106 to request your 1095-B. Mail a request for your 1095-B to:

The TPA, led by Select Health, a wholly owned subsidiary of Intermountain Health, will be known as Simplified Benefits Administrators and represents an expanded partnership between Intermountain Health and UCHealth.

Available in the App Store or Google Play, the Select Health mobile app has all the information you need, including these popular features: Health plan usage: See how much you've paid toward your deductible and out-of-pocket maximum. Medical cost estimator: Find out how much a service or a procedure will cost ...

There are four ways to get this form: Log in to your Select Health account and download your 1095-B under "Documents" Send an email to premiums@selecthealth.org to request your 1095-B. ... Call our Billing team at 844-442-4106 to request your 1095-B. Mail a request for your 1095-B to:

Together with Intermountain Health, we form a not-for-profit health system committed to going beyond treating illness and injury by encouraging healthy behaviors that can lead to longer, more fulfilling lives.

Select Health Share is revolutionary healthcare Select Health® and Intermountain Health®, together with partner employers and their employees, are working to create healthcare of the future—one that improves health and stabilizes healthcare costs.

Select Health is a non-profit health plan in Utah, Idaho, Nevada, and Colorado, with more than one million members across the United States. We are committed to helping our members and everyone in our communities stay healthy.

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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
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
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