Sample Client Education and Enrollment Materials
Please Note: These forms cannot be accepted for enrolling patients.
These are some sample client education and enrollment materials that you may review in order to familiarize yourself with the materials that will be sent to your patients.
(To find out how a client can enroll with a PCP, please visit our Client Enrollment page.)
- ICEB Health Plan Copayment Chart for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson counties
- ICEB Health Plan Comparison Chart for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson counties
- ICEB Health Plan Comparison Chart for Cook County
- ICEB Health Plan Comparison Chart for IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott
- ICEB Health Plan Copayment Chart for Cook County
- ICEB Health Plan Copayment Chart for IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott
- ICEB Initial Enrollment Letter for Cook County
- ICEB Initial Enrollment Letter for Cook County (Spanish)
- ICEB Initial Enrollment Letter for IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott
- ICEB Initial Enrollment Letter for IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott (Spanish)
- ICEB Initial Enrollment Letter for IHC and MCO for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson Counties
- ICEB Initial Enrollment Letter for IHC and MCO for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson Counties (Spanish)
- ICEB Initial Enrollment Letter for IHC Only
- ICEB Initial Enrollment Letter for IHC Only (Spanish)
- ICEB Enrollment Tips and Instructions
- ICEB Enrollment Tips and Instructions (Spanish)
- ICEB Enrollment Form
- ICEB Enrollment Form (Spanish)
- ICEB Enrollment Form IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott
- ICEB Enrollment Form IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott (Spanish)
- ICEB Information Guide IHC and MCO for Cook County
- ICEB Information Guide IHC and MCO for Cook County (Spanish)
- ICEB Information Guide IHC and MCO for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington, and Williamson counties
- ICEB Information Guide IHC and MCO for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington, and Williamson counties (Spanish)
- ICEB Information Guide IHC only
- ICEB Information Guide IHC only (Spanish)
- ICEB Information Guide IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott County
- ICEB Information Guide - IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott County (Spanish)
- ICEB Reminder Notice for Cook County
- ICEB Reminder Notice for Cook County (Spanish)
- ICEB Reminder Notice IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott
- ICEB Reminder Notice IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott (Spanish)
- ICEB Reminder Notice for IHC and MCO for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson Counties
- ICEB Reminder Notice for IHC and MCO for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson Counties (Spanish)
- ICEB Reminder Notice for IHC Only
- ICEB Reminder Notice for IHC Only (Spanish)
- ICEB Second Enrollment Letter for Cook County
- ICEB Second Enrollment Letter for Cook County (Spanish)
- ICEB Second Enrollment Letter IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott
- ICEB Second Enrollment Letter IHC and MCO for Adams, Brown, Henry, Lee, McHenry, Mercer, Pike, Rock Island and Scott (Spanish)
- ICEB Second Enrollment Letter for IHC and MCO for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson Counties
- ICEB Second Enrollment Letter for IHC and MCO for Jackson, Kane, Madison, Perry, Randolph, St. Clair, Washington and Williamson Counties (Spanish)
- ICEB Second Enrollment Letter for IHC Only
- ICEB Second Enrollment Letter for IHC Only (Spanish)
- ICEB Brochure
- ICEB Brochure (Spanish)
Illinois Client Enrollment Broker Client Enrollment Policy
Please download and review the Client Enrollment Policy
(Downloadable file requires Adobe Acrobat Reader - Free Download)
