see all offices

RBG, INDIANAPOLIS - FORMS
STARMARK RELEASED DOWNLOAD
Employer Enrollment
CONTINGENT OFFER FORM
7/21/2016   Download
ER APP
5/26/2016   Download
Employee Enrollment
AMENDMENT TO EE ELIGIBILITY STATEMENT

Description:
Required to provide with submissions that have approved non-Starmark EE apps. (pdf , 155k)

5/31/2016   Download
EE APP 51+

Description:
Self-funded employee enrollment for new groups enrolling in major medical or preventive care plans with 51 or more employee major medical lives. (pdf , 913k)

5/26/2016   Download
EE APP UNDER 50

Description:
Self-funded employee enrollment for groups enrolling in major medical or preventive care plans with 50 or fewer employee major medical lives (pdf , 851k)

5/26/2016   Download
EE ENROLLMENT CENSUS TEMPLATE

Description:
Self-funded employee enrollment for groups enrolling in preventive care plans. (lsx , 226k)

12/9/2015   Download
Administration
BILLING ADDRESS FORM

Description:
Complete to identify a group's physical and billing address (pdf , 94k)

5/26/2016   Download
Other
ADMIN GUIDE FOR EMPLOYERS
12/9/2015   Download
CARE CHAMPION FLYER
12/9/2015   Download
CDHP PLAN BENEFITS PRESENTATION

Description:
Educates employers with a CDHP about Starmark and their self-funded plan benefits. (pdf , 1190k)

12/9/2015   Download
PARTICIPATION FAQ

Description:
Provides answers to frequently asked questions regarding participation (pdf , 527k)

12/9/2015   Download
PPO PLAN BENEFITS PRESENTATION

Description:
Employers will learn about their self-funded plan benefits administered by Starmark. (pdf , 1218k)

12/9/2015   Download
RENEWAL/PLAN CHANGES FAQ
12/9/2015   Download
SELF FUNDING OVERVIEW BROCHURE
12/9/2015   Download
STATE MANDATE COMPARISON IN

Description:
Provides a comparison of state-mandated benefits by plan design. (pdf , 178k)

5/26/2016   Download
UNDERSTANDING YOUR MONTHLY BILL
12/9/2015   Download