State managed care documents
There are several states which provide an MCO program or require specific documents be posted or provided outside of a program. Each state has their own unique requirements for implementation and Zurich currently offers a program or has provided the required documents in the states listed below. Please select the state you are interested in to find the required documents or specific requirements and directions for program implementation. If you have any questions regarding the MCO programs or required documents, please send an email to mcaenrollment@zurichna.com.
If you are enrolled in any of the Zurich MPNs; ZSC Select MPN, Zurich Choice MPN (formerly known as First Health CompAmerica Select) or Zurich Primary MPN (formerly known as First Health CompAmerica Primary), the following is important information you will need:
MPN website: www.zurichna.com
MPN address: 1299 Zurich Way, Schaumburg, IL 60196-1056
Medical Access Assistant:866-732-5342 available Monday through Saturday 7:00 am to 8:00 pm Pacific time to provide employee assistance with access to medical care under the MPN
MPN Contact: Sheree Barros, MPN Contact and Grievance Coordinator 800-835-7169
MPN Materials: If you need to obtain a copy of The Complete Written Employee MPN Notification, Transfer of Care Policy Process , Continuity of Care Policy Process or a copy of the Second or Third Opinion Policy Process, you can request by contacting our MPN Contact at 800-835-7169.
MPN ID number: If you do not know or recall your MPN ID number from the original documents provided, please contact your employer or call us at 800-835-7169
OR
If your employer is Anthem, please click here for MPN information.
Employer Instructions
CA – Complete Written Employee MPN Notification (updated 7/1/2021)
Template - MPN Coverage Termination Notice to Employee
The employer should use their own letterhead for the template.
Additional Forms
Continuity of Care Plan Overview for Employees
Second and Third Opinion Plan Overview for Employees
Transfer of Care Plan Overview for Employees
If you would like to enroll or obtain education materials for this state, please send an email to mcaenrollment@zurichna.com.
For your convenience, Zurich is pleased to offer electronic funds transfer (EFT) payments. Learn more.
Enrollment Information
Enrollment Letter to Employer
Notice of Network Requirements
Employee Acknowledgement Form