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Gettysburg Health Administrators, Inc.
"Large enough to serve you. Small enough to know you."
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Forms
Please find forms below:
InterCounty Health Plans
Applications
Employer Master Application
InterCounty Employee Application
InterCounty Employee Application (25+ Employees)
Misc Forms
Employee Change Form
Prescription MailOrder Form
Prescription Reimbursement Form
Student Confirmation Form
Delta Dental Trust 2-4 Employees
Brochures
Delta 2-4 Lives Rate Sheet PA, MD, WV 2008
Delta Trust 2-4 Lives Brochure 2008
Misc Forms
Change / Termination Form
Delta 2-4 Lives Employee Change Form
Delta Dental Claim Form
Delta Dental SBA 5+ Employees
Applications
SBA Employee Application
SBA Employer Application
Brochures
Delta Dental PPO SBA (5+ Employees)
Delta Dental PPO Voluntary SBA (5+ Employees)
Delta Dental Premier SBA (5+ Employees)
DeltaCare USA SBA (5+ Employees)
DeltaCare USA Voluntary SBA (5+ Employees)
VSP - Vision Service Plan
Applications
Employee enrollment form
Group Application
VSP submission checklist
Brochures
VSP Brochure
Misc Forms
National-Regional Chains (Q&A)
PA VSP provider directory
CDHC - Consumer Driven Health Care (HRA/FSA/POP)
Applications
Employee Enrollment Form
Employee Information Change Form
Brochures
FSA Brochure
Misc Forms
FSA Calculation Sheet
FSA Dependent Care Claim Form
FSA Eligible Expense Listing
Medical Expense Reimbursement Claim Form
Online Employee Account Login Information Document
GettHealth® Misc. Forms
Misc Forms
Internet Acceptable Use Policy
Student Confirmation Form
Questionnaires
Accident Injury - Work Related Medical Condition
Other Insurance
MERP - Medical Expense Reimbursement Plan
Applications
MERP Employee Change Form
MERP Employee Enrollment Form
Misc Forms
MERP Claim Form
