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PIAG Region license # 0747420

Employer Forms/Documents

General

NEWPatient Protection and Affordable Care Act (PPACA/Obamacare)

COBRA information

Employee forms/Documents

Health Insurance Plans

Blue Shield

Kaiser Permanente

Custom Plans

Other Plans

Executive Benefit Option

Dental

Enrollment/Change forms

HIPAA Authorization form for Protected Health Information

Dental Claim Form

Vision

Mental Health

Life Insurance

Voluntary Term Life

Basic Group Life

Health Care Provider Links

MEDICAL
Blue Shield PPO (888) 235-1765 www.blueshieldca.com
Kaiser Permanente (404) 261-2590 http://my.kp.org/pibt/

 

DENTAL

Cigna Dental DPO & DMO (800) 367-1037 www.cigna.com
HUMANA PPO (800) 233-4013 www.humanadental.com
HUMANA DMO (Advantage Plus) (800) 979-4760 www.humanadental.com

 

VISION

EyeMed Vision Care (866) 939-3633 option 6 www.eyemedvisioncare.com
VSP Signature & Choice (800) 877-7195 www.vsp.com

 

MENTAL HEALTH

Employee Assistant Program EAP (800) 777-9355 www.members.mhn.com

Other Regions

Forms are tailored by region:

PINC
PIAG
PINC

For an evaluation of your insurance coverage today, please call the Insurance Department at (323) 728-9500.

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