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Agent Resources

Welcome Agents

Thank you for your partnership with Network Health. On this page, you'll find tools and resources to help you manage your business and quickly and easily distribute information to your clients. Our goal is to provide valuable resources to help you increase your productivity and bottom line.

As always, reach out to your account executive with feedback or questions. You can find our contact information in our Agent Reference Guide, or visit Contact Us for customer service and other key contacts.

Individual/Group Agency Portal
Agency Portal (Commissions)

Key Guides

Medicare Sales Material Agent Ordering Site
Our agent ordering site for Medicare agents to order sales kits, postcards, brochures and more.

Commercial Agent Portal Instructions
Instructions on how to access and use our commercial product agent portal.

Agent Guide
Your one-stop-shop to understanding all of Network Health's products.

Forms and Resources 

2019 Individual and Family Plans

2019 Plans and Product Sheets

2018 Plans and Product Sheets


Service Area

Medicare Advantage

Appointment of Representative Form
Change of Permanent Residence Address
Dental Reimbursement Form
Extra Help Low-Income Subsidy Form
Health Care Power of Attorney/Advance Care Planning
How to Read Your EOB
Mail Order Pharmacy Form
Medicare Online Application - Save and Finish Later
Medicare Plan Materials Page
Member Reimbursement Form
Member Resources Page
LEP Reconsideration Form
Payment Options Form
Pick Your Perks Member Reimbursement Form
Prescription Drug Claim Form
Protected Health Information Form
Scope of Appointment
Vision Reimbursement Form

Assure Forms and Resources

2022 Assure Standard EPO HSA Plans
2022 Assure Value EPO HSA Plans
2022 Assure Standard EPO Non-HSA Plans
2022 Assure Value EPO Non-HSA Plans
2022 Assure Standard POS HSA Plans
2022 Assure Value POS HSA Plans
2022 Assure Standard POS Non-HSA Plans
2022 Assure Value POS Non-HSA Plans
Assure ACH Form
Assure Application and Change Form
Assure Banking Arrangement Form
Assure Data Transmission Agreement
Assure Enrollment Application
Assure Group Application
Assure Enrollment Application - Spanish
Quoting Process
New York Public Goods Pool - 4264
New York Public Goods Pool - 4399
W-9
2021 Assure Standard EPO HSA Plans
2021 Assure Value EPO HSA Plans
2021 Assure Standard EPO Non-HSA Plans
2021 Assure Value EPO Non-HSA Plans
2021 Assure Standard POS HSA Plans
2021 Assure Value POS HSA Plans
2021 Assure Standard POS Non-HSA Plans
2021 Assure Value POS Non-HSA Plans

Individual Plan Forms and Resources

2021 Individual Plans
Individual and Family Plan Application and Change Form

 

Group Plan Forms and Resources

2022 Large Group HMO Plan
2022 Large Group HMO Plan Value Product
2022 Large Group POS Plan
2022 Large Group POS Plan Value Product
Application 51 to 100
Common Ownership Certification
Coordination of Benefits Form
Electronic Funds Transfer Form
Eligibility Certification
Employer Data Form
Master Employer Group Application
Membership Application and Change Form
Membership Application and Change Form - Hmong
Membership Application and Change Form - Spanish
Mid-sized Group Submission Checklist
Quoting Process
Small Employer Uniform Employee Application OCI 26-501
2021 Large Group HMO Plan
2021 Large Group HMO Plan Value Product
2021 Large Group POS Plan
2021 Large Group POS Plan Value Product

 


Network Health
1570 Midway Place
Menasha, WI 54952
Hours
Mon., Wed.-Fri.: 8 a.m. to 5 p.m.
Tuesday: 8 a.m. to 4 p.m.

Copyright 2021 Network Health Plan, Network Health Insurance Corporation and Network Health Administrative Services, LLC. All rights reserved. HMO and POS plans underwritten by Network Health Plan. Self-insured plans administered by Network Health Administrative Services, LLC. Network Health Medicare Advantage Plans include MSA, HMO and PPO plans with a Medicare contract. NetworkCares is a PPO D-SNP plan with a Medicare contract and a contract with the Wisconsin Medicaid program. Enrollment in Network Health Medicare Advantage Plans depends on contract renewal. Y0108_1850-02-0920_2021 Accepted 09292020 Last Updated Sep 17, 2021 12:34 PM

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