Documents & Forms
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156 results
2024 Employer Health Plans Brochure
2024 ID Individual and Family Policy Enrollment Form (Early Retirees)
2024 ID Large Group Brochure - Dental Only
2024 ID Large Group Master Application (Medical/Dental)
2024 ID Large Group Medical Plan Comparison - Navigator
2024 ID Large Group Medical Plan Comparison - Voyager
2024 ID Small Group Dental Only Plan Comparison
2024 ID Small Group Master Application (Medical/Dental)
2024 ID Small Group Medical Plan Comparison - Navigator
2024 ID Small Group Medical Plan Comparison - Voyager
2024 MT Individual and Family Dental Only Plan Comparison
2024 MT Large Group Brochure - Dental Only
2024 MT Large Group Master Application (Medical/Dental)
2024 MT Large Group Medical Plan Comparison - Navigator
2024 MT Small Group Dental Only Plan Comparison
2024 MT Small Group Master Application (Medical/Dental)
2024 MT Small Group Medical Plan Comparison - Navigator
2024 Navigator Network Flier - Idaho
2024 Navigator Network Flier - Montana
2024 OR Individual and Family Medical Plan Comparison - Navigator (Exchange)
2024 OR Large Group Brochure - Dental Only
2024 OR Large Group Master Application (Medical/Dental)
2024 OR Large Group Medical Plan Comparison - Navigator
2024 OR Large Group Medical Plan Comparison - Voyager
2024 OR Small Group Dental Only Plan Comparison
2024 OR Small Group Master Application (Medical/Dental)
2024 OR Small Group Medical Plan Comparison - Navigator
2024 OR Small Group Medical Plan Comparison - Voyager
2024 Voyager Network Flier
2024 WA Large Group Master Application (Medical/Dental)
2024 WA Large Group Medical Plan Comparison - Navigator
2024 WA Small Group Dental Only Plan Comparison
2024 WA Small Group Master Application (Medical/Dental)
2024 WA Small Group Medical Plan Comparison - Navigator
2024 WA Small Group Medical Plan Comparison - Voyager
2025 Employer Health Plans Brochure
2025 ID Individual and Family Dental Only Plan Comparison
2025 ID Individual and Family Medical Plan Comparison - Navigator
2025 ID Individual and Family Medical Plan Comparison - Voyager
2025 ID Individual and Family Plan Rates (Navigator)
2025 ID Individual and Family Plan Rates (Voyager)
2025 ID Individual and Family Policy Enrollment Form (Dental Only)
2025 ID Individual and Family Policy Enrollment Form (Medical and Dental)
2025 ID Large Group Brochure - Dental Only
2025 ID Large Group Master Application (Medical/Dental)
2025 ID Large Group Medical Plan Comparison - Navigator
2025 ID Large Group Medical Plan Comparison - Voyager
2025 ID Sample General Medical Limitations and Exclusions
2025 ID Small Group Dental Only Plan Comparison
2025 ID Small Group Master Application (Medical/Dental)
2025 ID Small Group Medical Plan Comparison - Navigator & Voyager
2025 ID/MT/OR Employee Enrollment and Waiver Form (Medical/Dental)
2025 Idaho Small Group Dental Exclusions
2025 MT Individual and Family Dental Only Plan Comparison
2025 MT Individual and Family Medical Plan Comparison - Navigator
2025 MT Individual and Family Plan Rates
2025 MT Individual and Family Policy Enrollment Form (Dental Only)
2025 MT Large Group Brochure - Dental Only
2025 MT Large Group Medical Plan Comparison - Navigator
2025 MT Small Group Dental Only Plan Comparison
2025 MT Small Group Master Application (Medical/Dental)
2025 MT Small Group Medical Plan Comparison - Navigator
2025 Navigator Network Flier - Idaho
2025 Navigator Network Flier - Montana
2025 OR Individual and Family Dental Only Plan Comparison
2025 OR Individual and Family Medical Plan Comparison - Navigator
2025 OR Individual and Family Medical Plan Comparison - Navigator (Exchange)
2025 OR Individual and Family Plan Rates
2025 OR Large Group Brochure - Dental Only
2025 OR Large Group Master Application (Medical/Dental)
2025 OR Large Group Medical Plan Comparison - Navigator
2025 OR Large Group Medical Plan Comparison - Voyager
2025 OR Small Group Dental Only Plan Comparison
2025 OR Small Group Master Application (Medical/Dental)
2025 OR Small Group Medical Plan Comparison - Navigator & Voyager
2025 Voyager Network Flier
About PacificSource Administrators
Balance Billing Protection Notice for ID
Balance Billing Protection Notice for MT
Balance Billing Protection Notice for OR
Balance Billing Protection Notice for WA
COBRA Benefit Administration Flier
COBRA Quick Guide FAQ
Common Ownership Form
Coordination of Benefits
Dependent Care Assistance Program (DCAP) Examples of Eligible and Ineligible Expenses
Employer Exemption Certification for Religious or Moral Objections - WA
FSA - Flexible Spending Account Administration Flier
Group Coverage Continuation Election Form (WA small group)
Group Identification Form - MT, OR, WA
Health Reimbursement Arrangement (HRA) Administration Flier
HRA Standard Plans at a Glance
HRA Supplemental Plans at a Glance
Large Group Census for ID
Large Group Census for MT
Large Group ID Self-Funded Dental Flier
Large Group MT Self-Funded Dental Flier
Large Group OR Self-Funded Dental Flier
Large Group Request for Quote (census form) - WA
Large Group WA Self-Funded Dental Flier
Navigator Network Flier - Oregon
Navigator Network Flier - Washington
PacificSource Foundation Impact Report
PacificSource Guide for Producers
PCORI Fee Information for Employers
Pharmacy Network for ID, MT, OR, and WA
Pharmacy Network for ID, MT, OR, and WA (Excel format)
Pharmacy Product Guidelines FAQ
Premium Only Plan (POP) Administration Flier
Premium Only Plan (POP) Service Agreement
Premium Only Plan (POP) Service Agreement - Idaho Only
Proposal Request: Fully Insured (Large Group 51-99) - WA
Proposal Request: Fully-Insured (Large Group 51-99) - ID
Prospective Agent Appointment Form
Quote Request for Small Groups
Renewal Confirmation Form
Request for Quote Large Group (51+) - MT
Self-Funded Administrative Solutions
Short Form Health Statement (required if no claims experience submitted) - MT
SmartAlliance Network Flier
Split Carrier Waiver of Coverage
Transportation Fringe Benefit
Universal Application (Mid-size Group 51-99) - ID
Value Based Preventive Drug List
Weight Management with WW