Forms and Resources

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Provider Search

	> Altius Health Plans
	> Great West
	> IHC Physician & Provider Directory
	> Regence BlueCross BlueShield
	> UnitedHealthcare Physician Directory

Forms & Applications

	> Altius Health Plans

	> IHC Personal Managed Care Plans - Application
	> IHC Personal Managed Care Plans - Change Form
	> IHC Small Employer Plans - Employee Application
	> IHC Small Employer Plans - Employee Change Form
	> IHC Small Employer Plans - Master Group Contract
	> IHC Small Employer Plans - Group Data Summary
	> IHC Small Employer Plans - Payment Authorization Form
	> IHC Small Employer Plans - Waiver Form
	> IHC Small Employer Plans - HIPAA Authorization Form

	> M/W Group Health Request Form (Excel Format)
	> M/W Group Health Request Form (PDF Format)

	> Regence BCBSU - Individual BlueChoices Application
	> Regence BCBSU - Individual Change Form
	> Regence BCBSU - Small Employer Group Application
	> Regence BCBSU - Small Employer Employee Enrollment/Waiver
	> Regence BCBSU - Small Employer Employee Health Statement
	> Regence BCBSU - Small Employer Employee PEC Credit Form
	> Regence BCBSU - Small Employer Change Form
	> Regence BCBSU - HIPAA Authorization Form

	> UnitedHealthcare - Small Employer Group Application
	> UnitedHealthcare - Small Employer Employee Application (2-9 Lives)
	> UnitedHealthcare - Small Employer Employee Application (10-50 Lives)
	> UnitedHealthcare - HIPAA Disclosure Form

Handbooks & Member Section

Altius Health Members Section - Access the Member Handbook & more

Chamber of Commerce / Partners

	> Salt Lake Chamber Group Health Request Form Excel (43kb) \| PDF (33kb)
	> Provo/Orem Chamber Group Health Request Form Excel (131kb) \| PDF (54kb)
	> St. George Chamber Group Health Request Form Excel (43kb) \| PDF (34kb)

Miller & Wade Group
3311 North University Ave, Suite 275
Provo, Utah 84604
801.377.1990
800.508.1144
Salt Lake City: 801.290.4753
St. George: 435.634.7333