Employer Group Spec Sheet

The employer group spec sheet contains information that we require when adding a new group to our system.

When signing up a new group, make sure all blanks are completed accurately. Incomplete information could lead to delays with the payor applying appropriate in-network discounts when processing the new group's claims.  

If you have questions, or need assistance, contact your PHN Payor Services Coordinator.

Forms can be downloaded from this web site. For your convenience, links are provided below.

Employer group spec sheet – PHN Only

Employer group spec sheet – Network Health Prevea PPO (Blended network)