Open Enrollment Forms/Documents for 07/01/10 Effective Date
     

Active Employees

Quantum Health Needs Assessment*
     HNA Letter
     HNA Form - Page 1
     HNA Form - Page 2
Quantum Primary Care Physician Designation*
     PCP Form - Page 1
     PCP Form - Page 2
*The Health Needs Assessment and the Primary Care Physician Designation
forms must be sent directly to Quantum:
     Coordinated Health/Care
     #229
     1215 Polaris Way
     Columbus, OH  43240-9920

Adult Children Forms
     Memo regarding Adult Children
     Questions/Answers - Insurance Benefits for Adult Children Up To Age 27
     Questionnaire for Adult Child's Employer
     Adult Child Health Insurance Coverage Affidavit

Important Provider Phone Numbers (Active Employees Only): 

Questions about covered services, prescription drugs, etc. contact the
   following providers:
     PPO Plan Questions for all
          1-800-360-7950
    Humana HMO Premier Questions for All
          1-888-393-6765     

Retirees
   MATC/UMR PPO Health Plan Form for enrollment or changes to coverage
   Humana HMO Health Plan Form for enrollment or changes to coverage
        Directions for Finding a Physician in the PPO
        Directions for Finding a Physician in the HMO
   Humana Dental Plan Form for enrollment or changes to coverage
    CarePlus Dental Plan Form for changes to coverage (no new enrollments)

  Memo regarding Adult Children
     Questions/Answers - Insurance Benefits for Adult Children Up To Age 27
     Questionnaire for Adult Child's Employer
     Adult Child Health Insurance Coverage Affidavit