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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

Health plan enrollment
Use this form to enroll in the health plan with Trustmark/Starmark

Pre-tax Election Form
Use this form to make your payroll deductions "pre-tax"

Special Enrollment Form
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

Health Benefits Summary
This document outlines your health benefits.

Glossary of Health Coverage and Medical Terms

Health Plan Document
This is a detailed description of your medical coverage.

Summary of Benefits & Coverage (SBC)

Temporary ID card
Use until your permanent card is issued and received.

Flu Shot Voucher for 2020-21
Use for 100% cvg for flu shot at any pharmacy. Not needed at your PCP.

Notice of Privacy Practices
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

Preferred Drug List 2019
With our PDL, you and your doctor have the freedom to choose the medication that works best for you.

Specialty Drug List

Making the Most of Your Prescription Benefit

CareMark Mail Service Order Form
Use this form to process prescription drug orders under the mail service plan.

CareMark Paper Claim Form
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.

CORONAVirus BENEFITS
FORMS & SUMMARIES
www.aeriebenefits.com
HOME / CONTACTFORMS & SUMMARIESREQUEST BENEFIT INFOFAQ'S LOCATE PROVIDERREGISTER / LOGINLEARNING CENTER

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HEALTH BENEFITS Website