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
- Baptist Health Plan
- Electronic Funds Transfer (EFT) Authorization Form
- Enrollment/Change Form
- Forma de Eleciones/Cambios – Español
- Forma de Renuncia – Español
- Large Group Contract Application for Indiana
- Large Group Contract Application for Kentucky
- Member Quick Reference Guide
- Small Group Contract Application For Kentucky
- Secure Portal Broker Access Request Form
- Secure Portal Employer Access Request Form
- Underwriting Guidelines
- Use and Disclosure Authorization Form
- Vision Hardware Reimbursement
- Waiver of Coverage Form
If you have any questions or need further assistance, please contact us at 859.335.4139.