Step 1 of 2: Medical profile   Gender Date of birth Height Weight Smoker? Applicant* M F / / Ft 4 5 6 7 In 0 1 2 3 4 5 6 7 8 9 10 11 Spouse -- M F / / Ft 4 5 6 7 In 0 1 2 3 4 5 6 7 8 9 10 11 Children 0  1 2 3 4 5 6         Children -- M F   / / Ft 4 5 6 7 In 0 1 2 3 4 5 6 7 8 9 10 11 Children -- M F   / / Ft 4 5 6 7 In 0 1 2 3 4 5 6 7 8 9 10 11 Children -- M F   / / Ft 4 5 6 7 In 0 1 2 3 4 5 6 7 8 9 10 11 Children -- M F / / Ft 4 5 6 7 In 0 1 2 3 4 5 6 7 8 9 10 11 Children -- M F   / / Ft 4 5 6 7 In 0 1 2 3 4 5 6 7 8 9 10 11 Children -- M F   / / Ft 4 5 6 7 In 0 1 2 3 4 5 6 7 8 9 10 11 Currently Insured?* Yes No Have conditions?* yes   no Please specify  Take medications?* yes   no Please specify  Step 2 of 2: Tell us about yourself First Name* Last Name* Address* City* State* Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip* Day Phone* Evening Phone* Contact Time* Morning Afternoon Evening Email* By submitting this form, you agree to be legally bound to, and abide by, the Privacy Policy.

Small Group PPO Providers

Open Choice®
This PPO plan gives your employees direct access to any recognized provider for covered benefits. Members can select a participating provider at lower out-of-pocket costs or a nonparticipating provider at higher out-of-pocket costs. The advantages of going to a participating provider are lower costs, no claim forms to file, and no balance bills.

CIGNA

CIGNA HealthCare PPO
HealthCare PPO provides access to participating physicians with no referrals, coverage for services out of the network, and preventive care options.

CIGNA HealthCare PPO Plus
HealthCare PPO Plus combines the freedom and open access of a PPO and the cost containment features of an HMO.
(Check out our small group HMO PROVIDERS )

UNITEDHEALTHCARE

UnitedHealthcare Options (PPO):
The Options PPO plan gives your employees access to a large network of doctors and hospitals with no referrals needed. Members can also see non-network physicians with no reduction in benefits. Employees can go to any physician, specialist or hospital, however out-of-network care results in somewhat higher deductibles and copayments.

UnitedHealthcare Options PPO Highlights

• Freedom to go to any physician or specialist
• Access to a nation-wide network
• Little or no out-of-pocket costs for network care
• Ideal for people who travel or have students in another state
• No claim forms or bills for network care

UnitedHealthcare Options PPO 80/80:
The Options PPO 80/80 plan allows your employees to manage their own health care decisions. Members can see any licensed medical provider for any covered service. Lower costs apply when visiting network physicians, hospitals, or providers.

UnitedHealthcare Options PPO 80/80 Highlights

• Go to any licensed medical provider
• See specialists without referrals
• Receive care at any hospital
• Access to a nation-wide network
• Lower costs for network care

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