KHI Agents
> Forms > Under Age 65
Coventry One
Applications
| Date | Form | Description | Download |
| March 2010 | GSA CHCIA | Application for Health Coverage Iowa | Link |
Plan Benefit Charts
| Date | Form | Description | Download |
| January 2011 | CHNI 263-1 | Plan Grids (Iowa, Nebraska, South Dakota) | Link |
| September 2009 | COV1 MEM PRE CARE | Preventive Care Chart (HealthCare Reform) | Link |
Rate Cards
| Date | Form | Description | Download |
| October 2011 | IA Rate Card - Effective 10/1/2011 | Link | |
| October 2011 | IA IHS (Community Plans Rate Card - Effective 10/1/2011 | Link | |
| October 2011 | NE Rate Card - Effective 10/1/2011 | Link | |
| October 2011 | SD Rate Card - Effective 10/1/2011 | Link |
Other Forms
| Date | Form | Description | Download |
| October 2008 | K002M0001 | Authorization Agreement for ACH Debit | Link |
| Provider Search Instructions (Iowa, Nebraska, South Dakota) | Link | ||
| January 2011 | Service Area Map | Link |
