Broker Downloads

2006 Plan Year

Brochures Seaman & Co, Premium Only Plan Brochure (POP Plan) CCB Renewal Letter – NEW! CCB Renewal Letter – Corrected – NEW! Forms POP Group Enrollment Form & Fact Finder Employer Group Enrollment Form - UPDATED Employee Application Form - UPDATED The Hartford Life & AD&D Enrollment Form Domestic Partner Affidavit Student Status Verification Form Notification of Qualifying Event Under COBRA Resources Sharp Hospital / Provider Location Map City of San Diego Business License Application Group Underwriting & Agent Requirements Proof of Eligibility Affidavit for Small Group - UPDATED New Group Submission Employer Checklist - UPDATED Rate Chart – UPDATED City Care Benefits FAQ’s Frequently Needed Contact Information Sharp Health Plan Materials Sharp HMO Medical Plan AC – High Option Sharp HMO Medical Plan AF – Low Option Sharp HMO Medical Plan L11 – Economy – NEW! Sharp RX 20/35/70 Rider – NEW! (Included with all Sharp Medical Plans) Sharp Free Wellness Programs Additional Sharp Wellness Programs Sharp Hospital / Provider Location Map Sharp Smart Partnership Sharp FAQ’s

Golden West Materials PPO Dental Plan RC1500 – High Option PPO Dental Plan RC1000 – Low Option HMO Dental Plan 89L3 – High Option HMO Dental Plan PCP – Low Option Orthodontia & Discount Vision Rider (Included with PPO & HMO Dental Plans) Cosmetic Benefit Rider (Included with HMO Dental Plans Only) Safeguard Plan Materials PPO Vision Plan I31 – High Option HMO Vision Plan PIV – Low Option American Specialty Health Plan Materials Chiropractic Only Plan CHI01 Chiropractic & Acupuncture Plan CAP01 Using your ASHPlan Golden West Voluntary Plan Materials PPO Dental Plan MAC1000V HMO Dental Plan PCPV Golden West Prepaid Plans FAQ’s Cosmetic Benefit Rider (Included with HMO Dental Plan Only) Orthodontia & Discount Vision Rider (Included with PPO & HMO Dental Plans) HMO Vision Plan 90GE The Hartford Plan Materials $20,000 Employee Term Life and AD&D Plan $2,000 Dependent Term Life Plan The Hartford FAQ’s Free Travel Assistance Program

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