These documents are mostly in Adobe Acrobat format. If you do not already have Acrobat installed please download the free reader.

County Health Pool - Frequently Asked Questions

Medical Summary Documents

2010 Plan A Benefit Summary
2010 Plan B500 Benefit Summary
2010 Plan B1000 Benefit Summary
2010 Plan HSA HDHP Benefit Summary

Medical Plan Documents

2010 Plan A SPD
2010 Plan B500 SPD
2010 Plan B1000 SPD
2010 Plan HDHP SPD

Medical Documents & Forms

Medical Claim Form
CDL Physical Claim Form
Health Fair Claim Form
Flu Shot Claim Form

Dental &Vision Documents & Forms

2010 Dental Plan A Summary
2010 Dental Plan B Summary
2010 Dental Comparison Summary

2010 Dental Plan A SPD
2010 Dental Plan B SPD

 

2009 Vision Benefit Summary
2010 Vision Benefit Summary
2009 Vision Plan Document

VSP Out-Of-Network Reimbursement Form

Attending Dentist Statement Form

Dental Claim Form for Medical Procedures

Prescription Forms

Prescription Drug Claim Form
Prescription Drug Mail Order Form

Other Documents

CHP HIPAA Privacy Notice
"Who to Call" Reference Sheet