Forms and Resources - Health Insurance Services Inc

Forms and Resources

Easy Resource Page

PSHP plans are unique and comprehensive, and are geared toward groups with members over age 65 enrolled in Medicare Parts A and B.

What is PSHP?

For your convenience, we encourage you to use this "easy resource" page for benefit grids, plan designs, and enrollment forms. Simply click on the appropriate pdf link. Should you need more information, please call: (855) 344-7747.

Getting Started

PSHP Features and Requirements
File Size:	148 kb
File Type:	pdf

Services Provided to Contracted Brokers
File Size:	142 kb
File Type:	pdf

Group Medicare Quote Request Form
File Size:	12 kb
File Type:	xlsx

Benefit Grids & Rates

PSHP 2020 Benefit Grids & Rates
File Size:	1066 kb
File Type:	pdf

2020 Enrollment Forms

PSHP New Group Enrollment Kit - Medical & Rx
File Size:	1222 kb
File Type:	pdf

PSHP New Group Enrollment - Medical Only
File Size:	843 kb
File Type:	pdf

PSHP New Group Enrollment Kit - Rx Only
File Size:	998 kb
File Type:	pdf

Rx Group Enrollment Kit for Current PSHP Medical-Only Sponsors
File Size:	863 kb
File Type:	pdf

PSHP Individual Member Enrollment Form (Medical and-or Rx)
File Size:	70 kb
File Type:	pdf

(888) 344-2522
306 S. Washington
Suite 206
Royal Oak, MI 48067
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