Name: AugerPros Plumbing and Drain
Price range: $$$

Congratulations! You are now eligible for Group Health Insurance at Auger Pros Plumbing!

We offer BCBS Silver HMO Advantage 820 plan. Attached are the plan details. 50% of your monthly premium will be taken out every month from your check (on a weekly prorated basis) and the company will pay the other 50% of your monthly cost. This benefit is for you individually. If you wish to also add your dependents or spouse, they may also be covered, however, their costs will be 100% paid by you and deducted from your weekly checks. You have the right to decline health insurance through Auger Pros Plumbing if you already have insurance through another company or if you are not interested in this benefit we offer. You or Auger Pros may cancel/change your insurance at any time during your employment with our Company. Your Insurance Benefits will be cancelled if you or Auger Pros choose to terminate your employment.

Do you Wish to Join our Group Health Insurance Plan that We Offer? *YesNo

Since our group plan is an HMO, you will need to choose who you want your Primary Care Doctor to be. We will need your primary care doctor's Primary Care Physician (PCP) # in order to process your application for health insurance.

You may either call your existing preferred Primary Care Doctor, and ask to make sure that they accept Blue Cross Blue Shield (BCBS) HMO plans, and if so, ask for their PCP #, or you may find it utilizing the following link.

Choose your Primary Care Provider

Clicking this button will take you to a new tab or window, choose your Primary Care Physician, then return to this tab to complete signing up. Click HERE to see a quick instruction on how to search for your Primary Care Physician.

Enter The Following Information regarding your Chosen Primary Care Doctor:

Primary Care Dr Name

Primary Care Dr PCP#

Primary Care Dr Address

Please provide the following info:

Your Name *

Your Address *

Your Phone *

Your Birth Date: (Month, Day, Year) *

Month *

Day *

Year *

Your Social Security # *

Will you also be paying for your dependents or spouse's premium? ( that would be 100% your cost) *YesNo

Please provide the following info for each person and indicate whether they are a spouse or dependent? Click add to add additional people.

Name

What is their relation to you?

Address

Phone

Birth Date: (Month, Day, Year)

Month

Day

Year

Social Security #

Primary Care Dr Name

Primary Care Dr PCP#

Primary Care Dr Address

Add another personYesNo

Name

What is their relation to you?

Address

Phone

Birth Date: (Month, Day, Year)

Month

Day

Year

Social Security #

Primary Care Dr Name

Primary Care Dr PCP#

Primary Care Dr Address

Add another personYesNo

Name

What is their relation to you?

Address

Phone

Birth Date: (Month, Day, Year)

Month

Day

Year

Social Security #

Primary Care Dr Name

Primary Care Dr PCP#

Primary Care Dr Address

Add another personYesNo

Name

What is their relation to you?

Address

Phone

Birth Date: (Month, Day, Year)

Month

Day

Year

Social Security #

Primary Care Dr Name

Primary Care Dr PCP#

Primary Care Dr Address

Thank you! Please type your name below as a signature, to represent that you have read and accept the terms of the insurance agreement.

Date

Sign/Type Name Here *