Select Health 100+


We’re the Mountain region’s highest-ranked health plan.

SelectHealth has ranked highest in member satisfaction among health plans in the Mountain region for five consecutive years. Our partnership with Intermountain Healthcare® and St. Luke’s Health System means that our members have access to some of the best hospitals, clinics, and doctors in the state. And for members who live outside of Idaho or Utah, our NationCare product provides great benefits at a competitive price.

Benefits they can offer:

  • Medical
  • Dental
  • Vision
  • Life
  • Long Term and Short Term Disability

All of these will need to be quoted by Select Health. Please contact our staff for additional information.


Quote Request Forms:

For quote and rate information for Select Health please contact our staff. Select Health for 100+ will require underwriting to review the information to determine if they will quote your group or decline to quote. Please note it can take 7 to 10 business days to go through the underwriting process. Please note our checklist which lists everything that we will need as well as optional items.

Select Health will take other carrier RFP forms in place of their forms for quote requests.



Large Group Checklist- 100+

Large Group Checklist- 51-99

2015 Employer Data Summary

2015 Employer Risk Evaluation

Large Group Census

  • You do not have to use this census we will just need the information on the census

2015 Emloyer Nationcare Application

  • We only need this for Nationcare Groups


We only need this if they did not have prior coverage

2015 Employee Enrollment Form



2015 Dental Sales Packet

2015 Employer Dental Data Summary



2015 Select Health Vision Flyer


Life and/or Disability Insurance

2015 Select Health Life and Disability Flyer

MetLife_Group Application

MetLife Risk Assessment Summary- STD or LTD

Metlife Request for Participation

Enrollment Census

  • No separate employee application is needed.


Servicing Forms:

Employee changes-

Change of address, change of name, dependent add or removal, and employee terminations.

2015 Employee Change Form

2015 Employee Nationcare Change Form

  • This is only for outside of Utah and Idaho employees


Provider Search:

Please click the below link for an up-to-date provider search.

SH Network


The forms posted on this page are for 2015. If you are interested in any forms for previous years or any pre-ACA plan forms please contact our staff.

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