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Applications

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• Application Packet
• TAA Application Packet
• Alaska Brochure
• Authorization Agreement For Preauthorized Payments
• Personal Representative Form

2012 Premiums

• PPO and Traditional Plans
• Medicare Carveout and Supplement Plans

2011 Premiums

• PPO and Traditional Plans
• Medicare Carveout and Supplement Plans

2011 Policies

Non-Medicare Plans

• PPO PLANS
• NON PPO PLAN

2010 Policies

Non-Medicare Plans

• PPO PLANS
• NON PPO PLAN
• Claim Form Non-Medicare

Medicare Plans

• MEDICARE CARVEOUT PLAN
• MEDICARE SUPPLEMENT PLAN A
• MEDICARE SUPPLEMENT PLAN F

Schedule of Benefits

• CARVEOUT PLAN - $1,000 Deductible, $2,500 Out-of-Pocket Maximum
• PLAN A-$1,000 Deductible, $2,500 Out-of-Pocket Maximum
• PLAN B-$1,500 Deductible, $3,000 Out-of-Pocket Maximum
• PLAN C-$2,500 Deductible, $5,000 Out-of-Pocket Maximum
• PLAN D-$5,000 Deductible, $10,000 Out-of-Pocket Maximum
• PLAN E-$10,000 Deductible, $15,000 Out of Pocket Maximum
• PLAN F-$1,000 Deductible, $2,500 Out-of-Pocket Maximum
• PLAN G-$15,000 Deductible, $25,000 Out-of-Pocket Maximum

Pharmacy

• Prescription Direct Claim Form