Aia Philadelphia 2007 rate request
This form should be completed if you are interested in a full benefits package.
- Please complete this form in its entirety as there is no way to stop and complete the information later.
- Only check off one selection in each step.
- If you would like to see rates for multiple plan options, you will need to complete the Rate Request form for each plan you would like to see.
- Groups with fewer than 10 employees can offer up to two plan options, one Keystone and one Personal Choice.
- Groups with 10 or more employees can offer up to three plan options, no more than two from each carrier, Keystone vs. Personal Choice.
- Sole proprietors and groups with one employee enrolling in the benefits can enroll in the Keystone HMO C3F4 with $20/40/60 Rx Plan only. You will have to be able to prove business ownership with either a UC2A report or a Schedule C.
If you have any questions about the Greater Philadelphia Cultural Alliance benefit plans, please feel free to contact Kristen Garry at 267.794.3010 or email her at .


