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Provider Search
 
Altius Health Plans
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SelectHealth Physician & Provider Directory
Regence BlueCross BlueShield
UnitedHealthcare Physician Directory



Forms & Applications
 
Altius Health Plans
 
Select Health Individual Plan Application
SelectHealth Small Employer Application
SelectHealth Small Employer Plans - Employee Application
SelectHealth Small Employer Plans - Master Group Contract
SelectHealth Small Employer Plans - Group Data Summary
SelectHealth Personal Managed Care - Plan Application
SelectHealth Personal Managed Care – Change Form
SelectHealth Personal Plan Product Options/Rates Brochure
SelectHealth Small Employer Plans – Employee Enrollment Form
SelectHealth Small Employer Plans – Employee Change Form
SelectHealth Small Employer Plans – Master Group Contract
SelectHealth Small Employer Plans – New Group Data Summary
SelectHealth Small Employer Plans – Payment Authorization Form
SelectHealth Small Employer Plans – Waiver Form
SelectHealth – HIPAA Authorization Form (Personal and Small Employer Plans)
SelectHealth Appeals 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)

 



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