In the General Forms section you will find “everyday” forms you will need for your AmeriHealth business needs.
Forms are in PDF format.
| Form | Last Updated |
|---|---|
| 51 + Group Enrollment Form | 2014-02 |
| 51+ NJ PPO HSA Declaration of Understanding w/ Rx | 2012-02 |
| 51+ NJ PPO HSA Declaration of Understanding w/o Rx | 2012-02 |
| AHNJ 65 Group Enrollment/ Change Form | 2012-02 |
| AHNJ Enrollment/Change Request Form (01412) | 2012-02 |
| AmeriHealth NJ Hearing-Aid Reimbursement Form | 2012-02 |
| AmeriHealth NJ Large Group Underwriting Guidelines | 2012-06 |
| AmeriHealth NJ Select Drug Program Q & A | 2012-02 |
| AmeriHealth NJ Small Employer Certification | 2014-03 |
| AmeriHealth NJ Traditional Pre-Authorization | 2012-02 |
| AmeriHealth New Jersey Claim Form | 2014-02 |
| AmeriHealth New Jersey Copay Reimbursement Form | 2014-02 |
| Application for Individual Coverage | 2014-02 |
| Bancorp Application - Declaration of Understanding | 2014-02 |
| COBRA Administration Form | 2012-08 |
| Employer Authorization for Access to AmeriHealth Express | 2012-02 |
| Employer Authorization for Access to AmeriHealth Express (Consultants) | 2013-07 |
| Employer Authorization for Electronic Withdrawl | 2012-02 |
| Enrollment Report: Additions, Changes and/or Removals | 2014-02 |
| Flexible Spending Account (FSA) Key Questions | 2012-02 |
| Future Scripts General Prior Authorization Form | 2014-02 |
| Future Scripts Health, Allergy & Medication Questionnaire (HMQ) | 2012-02 |
| Future Scripts Prescription Reimbursement Claim Form | 2014-02 |
| Group Application for Small Employer Health Benefits Policy | 2013-09 |
| Guest Advantage Application | 2014-02 |
| HIPAA Member Authorization Form | 2012-02 |
| Handicap Child Claim Form | 2014-02 |
| Health Accounts Enrollment Addendum | 2012-02 |
| Health Benefits Waiver of Coverage | 2014-04 |
| Health Reimbursement Account (HRA) Key Questions | 2012-02 |
| Out of Pocket Maximum Reimbursement Form | 2014-02 |
| Over-age Dependent Form | 2014-02 |
| Physician Recruit Form | 2014-02 |
| Point of Service Claim Form | 2014-02 |
| Pre-existing Condition Notification Form | 2012-02 |
| Prescription Mail Service Order Form | 2012-02 |
| Prior Credit and Fourth Quarter Carryover | 2014-02 |
| Procedures That Support Safe Prescribing - Fully Insured | 2012-02 |
| Procedures That Support Safe Prescribing - Self Insured | 2012-02 |
| SEH EPO HSA Declaration of Understanding | 2012-02 |
| SEH PPO HSA Declaration of Understanding | 2012-02 |
| SEH Pediatric Dental Attestation Form | 2014-05 |
| United Concordia Application for Group Dental Coverage | 2014-05 |
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