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:	110 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

PSHP Broker Toolkit
File Size:	1478 kb
File Type:	pdf

Benefit Grids & Rates

Benefit Grids — Medicare Parts A and B
File Size:	220 kb
File Type:	pdf

2019 Medical Rate Sheet
File Size:	170 kb
File Type:	pdf

Rx Formulary & Network

Preferred Chain Pharmacies - Only Applies to Groups of 2-5 Enrollees
File Size:	57 kb
File Type:	pdf

Preferred Independent Pharmacies - Only Applies to Groups of 2-5 Enrollees
File Size:	1054 kb
File Type:	pdf

Enrollment Forms

Group and Individual Enrollment Packet
File Size:	1004 kb
File Type:	pdf

(888) 344-2522
5640 W Maple Road
Suite 304
West Bloomfield, MI 48322
Click Here to Email Us

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West Bloomfield

Health Insurance Services Inc 
5640 W Maple Road
Suite 304
West Bloomfield, MI 48322
(888) 344-2522
Click Here to Email Us

Mequon

Health Insurance Services Inc 
11649 North Port Washington Road
Suite 200
Mequon, WI 53092
(888) 344-2522
Click Here to Email Us

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