About Broker Resources Provider Resources 330-363-6360 Contact Us Account Login Home Employer Resources Employer Documents The Area's Leading Employer Health Coverage AultCare's attention to our members, and our service focus to you, separates the employer health coverage we offer from other insurance companies. That's one of many reasons why more than 92% of AultCare clients renew with AultCare year after year. AultCare has always been committed to accuracy and improving processes. The forms are provided for your convenience. You may also find some of these resources, plus more, within your employer account. Employer Account Login Request a Quote Census Form — Complete this form and send it to AultCare Sales. Census Instructions — Electronic submission instruction guide. Claim Forms Accident Questionnaire — Provide additional information regarding accident or injury. Dental Claim Form — Form and instructions for filing a Dental Claim. Medical / Rx Claim Form — Form and instructions for filing a Medical/Rx Claim. Pharmacy Forms Vision Claim Form — Form and instructions for filing a Vision Claim. Enrollment Forms Other Coverage Information Form (electronic) Other Coverage Information Form — AultCare printable form for other coverage information. Guides QNXT 834-5010 Companion Guide AultCare Spreadsheet QNXT Companion Guide Explanation of Benefits and Appeals Document — Member Letter, Request for Review by the Ohio Department of Insurance, AultCare Treating Physician Certification for Experimental ABD, AultCare Treating Physician Certification for Internal Appeal Review, External Review Procedures Summary, External Review Request Form, and Internal Appeal Request Form. Sample Summary of Benefits — Examples of Summary of Benefits for Plans. Insured Administration Manual — Employer Registration Guide, File Retrieval Guide, and Blue Button Website Information. Membership Report & Instructions Miscellaneous Annual Determination of Group Size Demographics Form and Count Analysis Document Designation of Authorized Representative Form Glossary of Health Coverage and Medical Terms Sample Excel Invoice Population Health Management White Paper — A statistical analysis concluded AultCare members of a Population Health Management office are provided with better quality of care and save money. Care Coordination Services Population Health Management Learn more Serves as the link between the member, the Primary Care Physician (PCP), and the health plan to help the member navigate the healthcare system and receive integrated care Provider-based allowing for close partnerships with community providers Pharmacy Management Learn more Works alongside prescribing physicians to ensure your employees receive the most appropriate, cost-effective medications Disease Management Learn more Provides your employees with education on prevention; ensures employees with chronic health issues have the tools and services necessary to improve their health, including remote patient monitoring Case Management Learn more Equips employees with quality, cost-effective outcomes through assessment, planning, coordination, education, and referral Utilization Management Learn more Helps your company control costs through efficient management of healthcare resources Wellness Learn more Identifies and helps your employees understand their risks and assists in decreasing those risks through coaching, goal setting, education, encouragement, and support Dental DenteMax Learn more DenteMax is one of the largest leasable dental PPO networks in the United States DenteMax Provider Directory FAQs Electronic EOB FAQ Employer Guide to Services Glossary of Health Coverage and Medical Terms Network Access Network Hospitals CVS MinuteClinic Teladoc PHM Office Locations Cigna National Network Access Save Time and Money Transitioning to AultCare Online Mobile App Online Chat Pharmacy Services OptumRx Information How to Find a Pharmacy AultSaveRx Information AultSaveRx FAQ Pharmacy Services Transparency Transparency in Coverage IBM Medical Cost Estimator Reference-Based Pricing Vision Visit their website AultCare Phone: 800-344-8858 330-363-6360 TTY: 711 24-Hour Nurse Line: 866-422-9603 330-363-7620 Customer Service Hours: Monday - Friday 7:30 am - 5:00 pm EST Mailing Address: 2600 Sixth St S.W. Canton, OH 44710 IRS Notice 2020-76 AultCare Insurance Company will not be automatically mailing 2020 Form 1095-Bs to members. However, upon request, any applicable members can have their 2020 Form 1095-B. To receive your 2020 IRS Form 1095-B, submit the request via our CONTACT US on our website or send the request to: AultCare Insurance Company 2600 Sixth ST SW Canton, OH 44710 You can also call us at 330-363-6360 or 800-344-8858 with any questions. Your request will be furnished within 30 days of receipt. Additional Resources HIPAA Privacy Policy Terms & Conditions Language Access Quality Careers COVID-19 Information Social Non-discrimination Notice AultCare/Aultra complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sexual orientation, gender identity, or sex. AultCare/Aultra does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. AultCare/Aultra provides free aids and services to people with disabilities to communicate effectively with us, such as: Qualified sign language interpreters and written information in other formats (large print, audio, accessible electronic formats, other formats). AultCare/Aultra provides free language services to people whose primary language is not English, such as: Qualified interpreters and information written in other languages.If you need these services, or if you believe that AultCare/Aultra has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can contact or file a grievance with the: AultCare/Aultra Civil Rights Coordinator, 2600 6th St. S.W. Canton, OH 44710, 330-363-7456, CivilRightsCoordinator@aultcare.com. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, our Civil Rights staff is available to help you.You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services 200 Independence Avenue, SW Room 509F, HHH Building Washington, D.C. 20201 1-800-368-1019, 800-537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html © 2021 AultCare. All rights reserved.