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Enrollment Forms
Submissions Check List
Enrollment Material Order Form
2009 New Business Enrollment/Change Form (2 pages)
2009 New Business Enrollment/Change Form (page 1)
2009 New Business Enrollment/Change Form (page 2)
2009 Renewal Enrollment/Change Form
2009 Employer Agreement Form
2009 Employer Renewal Agreement Form
Electronic Debiting Form
2008 Enrollment Forms
2008 New Business Enrollment/Change Form (2 pages)
2008 New Business Enrollment/Change Form (page 1)
2008 New Business Enrollment/Change Form (page 2)
2008 Employer Agreement Form
2008 Employer Renewal Agreement Form
2007 Enrollment Forms
2007 New Business Enrollment/Change Form (2 pages)
2007 New Business Enrollment/Change Form (page 1)
2007 New Business Enrollment/Change Form (page 2)
2007 Employer Agreement Form
Claim Forms
GHI Claim Form
HIP Claim Form
Perfect Health Medical Claim Form
Perfect Health Hospital Claim Form
HRA Set Up Forms
Atlantis
Health Reimbursement Account Plan Application
HSA Set Up Forms
GHI
Employer Group Set-Up Form
GHI's HSA Q & A
PERFECT HEALTH
First HSA Application
CPA/Lawyer Attestation Letter
Transfer Deductible Credit
Perfect Health's Network Usages Rules
Renewal Letters
July 2008 Renewal Letter

Enrollment and Correspondence Address:
LIA Health Alliance
Enrollment Processing Center
48 South Servcie Road
Suite 301A
Melville NY 11747
1-800-542-5513
Fax TBA

Bill Payments Address:
LIA Health Alliance
P.O. Box 48335
Newark, NJ 07101-4835

If you have any questions, please call 1-800-LIA-5513
 
LIA Health Alliance Website 2008