Inclusive Health Federal Option 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 Forms

• 2012 Enrollment Application (FED) - print version | online version
  
• IH Member Change Form - print version | online version
  
• Enrollment Checklist
  
• Automatic bank draft application
  
• List of qualifying medical conditions for Federal Option
  

Rate Table

• Inclusive Health - Federal Option Rate Table
  

Federal Policy Plan Information

• PPO 1000 | PPO 2500 | PPO 3500
| HDHP 4500

Additional Information

• IH Federal Brochure
  
• ID Card (sample)
  
• Explanation of Benefits