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Prescription Drug Info
Benefits Info
Referral Kit
Forms
FAQ's
Forms

For your convenience you may access the most commonly used documents by
following the links below. All of the forms and brochures are in PDF format.
If you do not have Adobe Acrobat Reader, download it here.



Application Kit
2010 Enrollment Application - print version | online version
Enrollment Checklist
HCTC Addendum for Enrollment Application
Automatic bank draft application
List of qualifying medical conditions
January 1, 2010 Rates Tobacco Users
January 1, 2010 Rates Non-Tobacco Users
Release of Information - Authorized Representative Form
IH Assist Premium Subsidy Program Application

IH Policy Plan Information
PPO 1000
PPO 2500
PPO 3500
High Deductible Health Plan 5000 (HDHP)
Notice of privacy practices
IH Member Change Form

File a Claim
Claim form
Pharmacy Claim Form

Marketing Materials
Inclusive Health tri-fold brochure
Buckslip
Inclusive Health ID Card (sample)
Inclusive Health Explanation of Benefits

Health Care Savings Account Information
HSA Application
Information on Health Care Savings Accounts from HSA Bank

North Carolina Health Insurance Risk Pool, Inc.
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