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InsureOne Benefits - Providing Personal Health Insurance Solutions

Benefit Summaries & Forms

Benefit Summaries

SuperMed One

  1. Standard, Copay
  2. Standard, No Copay
  3. Short Term
  4. HSA 80
  5. HSA 100
  6. Wellness HSA 80
  7. Wellness HSA 100
  8. Value
  9. Vision
  10. Dental

Ohio Farm Bureau

  1. Standard 80
  2. Standard 90
  3. Wellness HSA 80
  4. Wellness HSA 100
  5. Value
  6. High Deductable
  7. Vision
  8. Dental

Anthem

  1. Blue Access
  2. Blue Short Term
  3. Lumenos HSA
  4. Lumenos HIA
  5. Lumenos HIA Plus
  6. Blue Access Value
  7. Blue Access Economy

Applications

SuperMed One

Apply Online

  • Standard Application
  • Short-Term Application

Ohio Farm Bureau

Apply Online

  • Standard Application
  • OFB New Member Application

Anthem

Apply Online

  • Standard Application
  • Short-Term Application

Forms

MMO Claim Forms

  • Major Medical Claim Form
  • Prescription Drug Claim Form
  • Dental Claim Form
  • Vision Claim Form
  • Hearing Claim Form

MMO Verification Forms

  • Cobra Waiver Approval
  • Disability/Overage Dependant Verification Form
  • Student Certification Form

Misc Forms

  • Underwriting Exception Request
  • Medco by Mail Order Form

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