Cigna + Oscar

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Form Name Effective Date Download Form
New Group Submission
Employer Application 1.21
01/01/2021 Download
ACH Authorization Form
01/01/2021 Download
Corporate Officer/Proprietor/Partner Verification Statement
01/01/2021 Download
Form Name Effective Date Download Form
Enrollment and Change Forms
Employee Enrollment & Change Form 1.21
01/01/2021 Download
Employee Waiver Form 1.21
01/01/2021 Download
Form Name Effective Date Download Form
2021 Medical EPO
LocalPlus Network
LocalPlus Platinum 0 Option 1
01/01/2021 Summary SBC
LocalPlus Platinum 0 Option 1 INF
01/01/2021 Summary SBC
LocalPlus Platinum 0 Option 2
01/01/2021 Summary SBC
LocalPlus Platinum 0 Option 2 INF
01/01/2021 Summary SBC
LocalPlus Platinum 250
01/01/2021 Summary SBC
LocalPlus Platinum 250 INF
01/01/2021 Summary SBC
LocalPlus Platinum 500
01/01/2021 Summary SBC
LocalPlus Platinum 500 INF
01/01/2021 Summary SBC
LocalPlus Gold 0
01/01/2021 Summary SBC
LocalPlus Gold 0 INF
01/01/2021 Summary SBC
LocalPlus Gold 250
01/01/2021 Summary SBC
LocalPlus Gold 250 INF
01/01/2021 Summary SBC
LocalPlus Gold 750
01/01/2021 Summary SBC
LocalPlus Gold 750 INF
01/01/2021 Summary SBC
LocalPlus Gold 1200
01/01/2021 Summary SBC
LocalPlus Gold 1200 INF
01/01/2021 Summary SBC
LocalPlus Silver 1700
01/01/2021 Summary SBC
LocalPlus Silver 1700 INF
01/01/2021 Summary SBC
LocalPlus Silver 2000
01/01/2021 Summary SBC
LocalPlus Silver 2000 INF
01/01/2021 Summary SBC
LocalPlus Silver 2250 Option 1
01/01/2021 Summary SBC
LocalPlus Silver 2250 Option 1 INF
01/01/2021 Summary SBC
LocalPlus Silver 2250 Option 2
01/01/2021 Summary SBC
LocalPlus Silver 2250 Option 2 INF
01/01/2021 Summary SBC
LocalPlus Bronze 6000
01/01/2021 Summary SBC
LocalPlus Bronze 6000 INF
01/01/2021 Summary SBC
LocalPlus Bronze 6300
01/01/2021 Summary SBC
LocalPlus Bronze 6300 INF
01/01/2021 Summary SBC
LocalPlus Bronze 5500 HSA
01/01/2021 Summary SBC
LocalPlus Bronze 5500 HSA INF
01/01/2021 Summary SBC
LocalPlus Bronze 6500 HSA
01/01/2021 Summary SBC
LocalPlus Bronze 6500 HSA INF
01/01/2021 Summary SBC
Open Access Plus Network
Open Access Plus Platinum 0 Option 1
01/01/2021 Summary SBC
Open Access Plus Platinum 0 Option 1 INF
01/01/2021 Summary SBC
Open Access Plus Platinum 0 Option 2
01/01/2021 Summary SBC
Open Access Plus Platinum 0 Option 2 INF
01/01/2021 Summary SBC
Open Access Plus Platinum 250
01/01/2021 Summary SBC
Open Access Plus Platinum 250 INF
01/01/2021 Summary SBC
Open Access Plus Platinum 500
01/01/2021 Summary SBC
Open Access Plus Platinum 500 INF
01/01/2021 Summary SBC
Open Access Plus Gold 0
01/01/2021 Summary SBC
Open Access Plus Gold 0 INF
01/01/2021 Summary SBC
Open Access Plus Gold 250
01/01/2021 Summary SBC
Open Access Plus Gold 250 INF
01/01/2021 Summary SBC
Open Access Plus Gold 750
01/01/2021 Summary SBC
Open Access Plus Gold 750 INF
01/01/2021 Summary SBC
Open Access Plus Gold 1200
01/01/2021 Summary SBC
Open Access Plus Gold 1200 INF
01/01/2021 Summary SBC
Open Access Plus Silver 1700
01/01/2021 Summary SBC
Open Access Plus Silver 1700 INF
01/01/2021 Summary SBC
Open Access Plus Silver 2000
01/01/2021 Summary SBC
Open Access Plus Silver 2000 INF
01/01/2021 Summary SBC
Open Access Plus Silver 2250 Option 1
01/01/2021 Summary SBC
Open Access Plus Silver 2250 Option 1 INF
01/01/2021 Summary SBC
Open Access Plus Silver 2250 Option 2
01/01/2021 Summary SBC
Open Access Plus Silver 2250 Option 2 INF
01/01/2021 Summary SBC
Open Access Plus Bronze 6000
01/01/2021 Summary SBC
Open Access Plus Bronze 6000 INF
01/01/2021 Summary SBC
Open Access Plus Bronze 6300
01/01/2021 Summary SBC
Open Access Plus Bronze 6300 INF
01/01/2021 Summary SBC
Open Access Plus Bronze 5500 HSA
01/01/2021 Summary SBC
Open Access Plus Bronze 5500 HSA INF
01/01/2021 Summary SBC
Open Access Plus Bronze 6500 HSA
01/01/2021 Summary SBC
Open Access Plus Bronze 6500 HSA INF
01/01/2021 Summary SBC
Form Name Effective Date Download Form
Under Construction
Form Name Effective Date Download Form