Summary of Benefits

• Open Access POS Plan $500 100%
• Open Access POS Plan $1,000 80%
• PPO Plan $500 100%
• Dental / Vision / Life
• Long-Term Disability

BCBS-GA Administrative Forms

• Employee Enrollment Form
• Member Change Form
• Cancellation Form
• HIPAA Privacy Authorization Release
• Privacy Policy

Principal Administrative Forms

• Employee Enrollment Form
• Member Change Form
• HIPAA Privacy Authorization Release
• Privacy Policy

Claim Forms

• Medical
• Dental
• Express Scripts Mail Order Rx
• Vison
• Disability

Disclosures

• Important Plan Disclosures
• Sample Initial COBRA Notice

Let Us Serve You…

Your Human Resources Department is here to serve you. Let us know if you have any questions or concerns regarding our benefits package. Contact us today…

Cheris Craig
cheriscraig@yahoo.com
770-692-1351 – voice
770-389-8674 – fax

Urology of Greater Atlanta, LLC
290 Country Club Drive, Suite 100
Stockbridge, GA 30281

Our Insurers

Click on the insurer logo to be directed to its web site. There you may search for participating providers and access other on-line services.

Helpful Information

• BCBSGA_Nurseline
• 360 Degree Health
• Emergency Room Alternative
• Health Improvements
• Employee’s Guide to COBRA
• Your Rights Under FMLA
• Guide to HIPAA Portability
• Uniformed Services Employment and Reemployment Rights Act
• Privacy and Your Health Information
• Medicare & You