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Who is Eligible?

Enrollment Checklist

Benefit Information

Get a Quote

Forms

Apply Now!

Renew/Terminate Coverage

Contact an Agent


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Inclusive Health 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.




Federal Option Plan Forms

State Option Plan
Forms


Additional Forms for both STATE and FEDERAL Options

  • HSA Application
  • Helpful link for Q & A on HSA accounts
  • Information on Health Care Savings Accounts from HSA Bank
  • Release of Information - Authorized Representative Form
  • IH Notice of Privacy Practices
  • IH Medical Claim Form
  • MedTrak Member Claim Form
  • How to register on the MedTrak website
  • Preferred Pharmacy MedTrak Network


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North Carolina Health Insurance Risk Pool, Inc.
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