Products Offered Online Products Offered Paper Application Agent's Commission Statements Request Your Online Enrollment Link Marketing Materials & Forms Important Links Agent Testimonials Marketing Materials & Forms Adobe Reader required to read the forms. Guarantee Issue Health Insurance Value Access Guarantee (Not available in: CA, CT, HI, ID, IN, MD, MN, MT, NH, NJ, NY, OR, SD, WA, WV) Value Guarantee (Not available in: CT, KY, LA, MA, ME, NJ, NY, OR, UT, WA) Premier Assurance (Not available in: CT, KY, LA, MA, ME, NJ, NY, OR, UT, WA) Alabama Residents VBA Form Value Health Plan Value Health Plan for all states except: AL, CT, KY, LA, MA, ME, NJ, NY, OR, UT, WA Value Health Plan For Alabama Value Health Plan USA Value Health USA Plan for all states except: AL, CT, KY, LA, MA, ME, NJ, NY, OR, UT, WA Value Health USA Plan For Alabama Value Med Plan Alabama Alaska Arizona Arkansas California Colorado Delaware DC Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kentucky Louisiana Maryland Michigan Mississippi Missouri Nebraska Nevada New Mexico Ohio Oklahoma Oregon Pennsylvania South Carolina South Dakota Tennessee Texas Utah Virginia West Virginia Wisconsin Wyoming VBA 24 Hour Accident Coverage 100% Medical Expense Benefit Limited Medical Expense Benefit (Lower Cost Membership) CallMD – Doctor on Call 24/7 CallMD – Available in All States and All Ages VBA Trucker Occupational Accident Plan VBA Trucker Occupational Accident Plan for all states except: NC, NJ, NY, OR List Bill Forms Value Health USA, Value Health, Value Guarantee & Plans (Voluntary & Employer Paid) (GEM will process the monthly billing.) VBA Accident, Value Access Coverage (VBA will process the monthly billing.) Value Med Plan (GTL states) (GTL will process the monthly billing.) Value Med Plan (UNL states) (UNL will process the monthly billing.) HIPAA Authorization Forms - Required with every application Value Health Plan (AIG) Value Med Plan (GTL/UNL) Agent Underwriting Guidelines Value Med Plans Value Health / Value Health USA Required & Miscellaneous ValuePlans – State Approval Grid Agent Authorization for Auto Bank Deposit GAC Commission Statement Explanation Commission Assignment Forms Criminal Background Release for (Georgia and Mississippi Agents) Value Health Plans & Value Med Plan Rate Calculation & Bank Draft form PAYMENT CHANGE REQUEST FORM Value Health USA / Value Health & Value Guarantee Consumer form Monthly Newsletters July - 2010May - 2010April - 2010February - 2008January - 2008April - 2006March - 2006February - 2006January - 2006May - 2006June - 2006July - 2006April - 2007March - 2007January - 2007December - 2006November - 2006October - 2006September - 2006August - 2006May - 2007