Virtual Web Solutions
Enrollment Forms
All completed enrollment forms should be sent to our broker:
Resource Equity Group, P.O. Box 5556, Greenville, SC 29606
OR, fax to 864-242-0698,
OR, email to mailbox@regroupusa.com
Use this form to enroll in the health plan with Trustmark/Starmark
Use this form to make your payroll deductions "pre-tax"
Use this form along with the Health plan enrollment form above when
you are enrolling during a qualifying life event (i.e., loss of other coverage). Use when originally waived coverage.
General Health Insurance Forms
This document outlines your health benefits.
This is a detailed description of your medical coverage.
Use until your permanent card is issued and received.
Use for 100% cvg for flu shot at any pharmacy. Not needed at your PCP.
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Prescription Drug Forms
With our PDL, you and your doctor have the freedom to choose the medication that works best for you.
Use this form to process prescription drug orders under the mail service plan.
and FAQs
Use this form to obtain reimbursement for a prescription drug.
Miscellaneous Forms
GRAND ROUNDS. Whether you need information about a new diagnosis or treatment, or support deciding if surgery is right for you, a second opinion from Grand Rounds can help. This service is available to you, at no additional
cost, as part of your health benefit plan. To access Grand Rounds,
call 877-849-6077, or go to www.grandrounds.com/starmark
TELADOC. With Teladoc, you can talk to a licensed physician in minutes once you are registered, from wherever you are. Call Teladoc at 800-835-2362, or go to www.teladoc.com, or download the mobile app at The AppStore or Google play.
FORMS & SUMMARIES
www.aeriebenefits.com
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HEALTH BENEFITS Website
