For Businesses with 1-100 Employees
Please check out our Administration Handbook*. This manual provides you with a summary of the administrative information that will help you successfully administer your plan for your employees. Of particular importance is the information about how to submit data accurately and on time.
For your convenience, the Customer Service Information section of the manual contains a list of phone numbers and addresses for the departments you will need to contact as you administer your benefits program.
*Information does not apply to Plan Sponsors who enrolled using the Innovation Health Private Exchange
Note: As you read through this manual, you may encounter specific terms or references that do not apply to the plan of benefits you have selected. The actual terms of your group plan are detailed in the plan documents we issued to you.
Innovation Health Premium Payments:
Employers with 1 – 50 employees can click here to make a premium payment.
Enrollment Forms
- Employer Application (for businesses with 1 - 50 eligible employees)
- Employer Application (for businesses with 51 - 100 eligible employees)
- Employee Enrollment/Change Form (for businesses with 1 - 50 eligible employees)
- Employee Enrollment/Change Form (for businesses with 51 - 100 eligible employees)
- ACA 1557 Notice of Non-Discrimination and Language Assistance Taglines
- Automated Clearing House (ACH) New Business Request Form
- Evidence of Insurability Employee must complete this form for approval of Life Insurance Elections over the Guaranteed Issue Amount which is $20,000 for groups 2-9 employees, $75,000 for groups 10-25 employees and $100,000 for groups 26-50; or Late Enrollee for Life and/or Disability – an individual enrolling more than 31 days from the date first eligible is considered a late enrollee. Benefits are offered through Aetna.
- Attending Physician's Statement for Coverage of Dependent Student on a Leave of Absence Due to a Serious Illness or Injury (Michelle's Law) (PDF/UA).
- Request for Coverage of Dependent Student on a Leave of Absence Due to a Serious Injury (Michelle's Law) (PDF/UA).
- Maryland Group Medical Expense Benefits Right of Continuation Notice for Divorced Spouse (PDF/UA).
- Maryland Group Medical Expense Benefits Right of Continuation Notice for Surviving Dependents/Termination of Employment (PDF/UA).
- Virginia Group Medical Continuation Notice (PDF/UA).
- Special Dependent Form (PDF/UA).
- Special Dependent Form (Spanish) (PDF/UA).
- Special Dependent Form CA
- Special Dependent Form (Spanish) CA
For customized or consolidated enrollment forms please contact your Account Manager and/or Broker.
For Businesses with more than 100 Employees
Enrollment Forms
- PPO Employee Enrollment/Change Form
- PPO Employee Enrollment/Change Form (Spanish)
- HMO Employee Enrollment/Change Form
- HMO Employee Enrollment/Change Form (Spanish)
- ACA 1557 Notice of Non-Discrimination and Language Assistance Taglines
- Attending Physician's Statement for Coverage of Dependent Student on a Leave of Absence Due to a Serious Illness or Injury (Michelle's Law) (PDF/UA).
- Request for Coverage of Dependent Student on a Leave of Absence Due to a Serious Injury (Michelle's Law) (PDF/UA).
- Maryland Group Medical Expense Benefits Right of Continuation Notice for Divorced Spouse (PDF/UA).
- Maryland Group Medical Expense Benefits Right of Continuation Notice for Surviving Dependents/Termination of Employment (PDF/UA).
- Virginia Group Medical Continuation Notice (PDF/UA).
- Special Dependent Form (PDF/UA).
- Special Dependent Form (Spanish) (PDF/UA).
- Special Dependent Form CA
- Special Dependent Form (Spanish) CA
For customized or consolidated enrollment forms please contact your Account Manager and/or Broker.
For Businesses with an Innovation Health Funding Advantage self-insured health plan
Please check out our Administration Manual. We designed this administrative handbook to summarize all the information you need to work with Innovation Health as we help administer your self-insured plan. That way, you can get back to doing what’s most important to you — running your business!
Note: As you read through this manual, you may encounter specific terms or references that do not apply to the plan of benefits you have selected. The actual terms of your group plan are detailed in the plan documents we issued to you.
Together, better health
Inova and Aetna have partnered to transform the patient health care journey. Through integrated, coordinated team communication and innovative programs, our plans are personalized to fit your needs, at any stage. Discover how we help members achieve their health ambitions, right in their community.
