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Enrollment Forms
Submissions Check List
Enrollment Material Order Form
2008 New Business Enrollment/Change Form (2 pages)
2008 New Business Enrollment/Change Form (page 1)
2008 New Business Enrollment/Change Form (page 2)
2007 New Business Enrollment/Change Form (2 pages)
2007 New Business Enrollment/Change Form (page 1)
2007 New Business Enrollment/Change Form (page 2)
2008 Employer Agreement Form
2007 Employer Agreement Form
2008 Employer Renewal Agreement Form
Electronic Debiting 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
Renewal Letters
July 2008 Renewal Letter

Enrollment and Correspondence Address:
LIA Health Alliance
Enrollment Processing Center
1717 Veterans Memorial Highway
Suite 4
Islandia, NY 11749
1-800-542-5513
Fax 631-840-1219

Bill Payments Address:
LIA Health Alliance
P.O. Box 48318
Newark, NJ  07101-4818

If you have any questions, please call 1-800-LIA-5513
 
LIA Health Alliance Website 2007