Helpful Broker Resources and Forms
Below are several important resources and forms for brokers. Please contact Baptist Health Plan if you have any questions or need sales support. We look forward to working with you.
Baptist Health Plan Advantage Brokers
We distribute our Medicare Advantage products through Field Marketing Organizations (FMOs). Please contact one of our authorized FMOs listed below for assistance with broker appointments and to learn more about training requirements or commissions. You can also click here for access to the Baptist Health Plan Advantage Broker Resource site.
Commercial Baptist Health Plan Brokers
- Don’t wait for a quote! Access the Broker Rating Tool for Small Groups by clicking here!
- Baptist Health Plan Checklist for Small Group 2016-2017
- Electronic Funds Transfer (EFT) Authorization Form
- Prescription Claim Form
- Forma de Eleciones/Cambios – Español
- Forma de Renuncia – Español
- Enrollment/Change Form
- Group Health Questionnaire
- Large Group Contract Application For Kentucky
- Small Group Contract Application For Kentucky
- Indiana Group Contract Application
- Employee Census Data Form
- Quote Request Form
- Quote Request Interactive Form (Coming Soon!)
- Underwriting Guidelines
- Large Group Underwriting Form
- Use and Disclosure Authorization Form
If you have any questions or need further assistance, please contact us at 859.335.4139.