Documents Library
Listed below are brochures, applications and relevant forms for the PBT Group, Individual and Additional Life and Health Insurance Plans. For additional information or help with the application process, please call 1.800.621.0748 and one of our Customer Service Representatives will be happy to assist you.
Group Coverage:
Group Health Benefits Program Brochure
Group Privilege Plan Flyer
2010 Deductible For Health Savings Account (HSA) Qualified High Deductible Health Plans
Group Health Benefits Request for Quote Form
Group Health Benefits Program Application and Change of Coverage Form
Employer Application and Agreement Form
Health History Questionnaire
Optional Coverage Solutions Brochure
Individual Coverage:
Individual Health Benefits Program Brochure
2010 Deductible For Health Savings Account (HSA) Qualified High Deductible Health Plans
Individual Health Benefits Request for Quote Form
Individual Health Benefits Program Application
Individual Change of Coverage Form
Health History Questionnaire
PBT Preferred Choice Indemnity Plans Chart
PBT Preferred PPO Plans Chart
PBT Preferred Health Savings Account Qualified Plans Chart
PBT Value PPO Plans Chart
PBT Value Health Savings Account Qualified Plans Chart
PBT Major Medical High Deductible Plan Chart
Census Form
PBT MediCap Medicare Supplement Insurance - for Members Turning 65
Focused on Medicare Newsletter
Turning 65 MediCap Enrollment Form
Outline of Coverage - Cover page
Your Guide to Physicians' Benefits Trust Medicare Supplement Insurance Portfolio of Plans
Plan A Outline of Coverage
Plan F Outline of Coverage
Plan Rates
PBT MediCap Medicare Supplement Insurance - for Members Age 65 and Over
MediCap - Medicare Supplement Plans Application
Outline of Coverage - Cover page
Your Guide to Physicians' Benefits Trust Medicare Supplement Insurance Portfolio of Plans
Plan A Outline of Coverage
Plan F Outline of Coverage
Plans Rates
Additional Life and Health Insurance Plans:
Dental Protection Plan Flyer
Dental Protection Plan Application
Health History Questionnaire
Term Life Brochure
Term Life Rates
Term Life Application
Long Term Personal and Business Disability Income Brochure
Long Term Personal and Business Disability Income Rates
Long Term Disability Application
Business Overhead Expense Application
Accidental Death and Dismemberment Brochure
Accidental Death and Dismemberment Application
Claim Forms:
Dental Claim Form
Medical Claim Form
