AAAHI Enrollment

How to Enroll in the Freedom Plan

  • STEP 1: Download the CoOp Membership Agreement and save it on your desktop or in a folder. The form is an interactive PDF and can be filled out electronically. If you prefer, you may print, fill it out by hand, and scan before submitting the form in Step 2.
  • STEP 2: After downloading, completing, and signing the CoOp Membership Agreement, send it to the CoOp by clicking the Submit button, and attaching it to the bottom of the submission form.
  • STEP 3: Download the AAAHI Member Information Form and save it on your desktop or in a folder. The form is an interactive PDF and can be filled out electronically. If you prefer, you may print, fill it out by hand, and scan before submitting the form in Step 7.
  • STEP 4: Download the ACH Recurring Authorization Form and save it on your desktop or in a folder. The form is an interactive PDF and can be filled out electronically. Print the completed the form, sign it, attach a voided check, scan the completed form with voided check, upload, and submit in Step 7.
  • STEP 5: Download the W-9 Form and save it on your desktop or in a folder. The form is an interactive PDF and may be filled out electronically (or by hand), however it must have a written signature so after completing the W-9, and signing the document, scan it before submitting it in Step 7.
  • STEP 6: Download the Cost Calculator Form and save it on your desktop or in a folder. The form is an interactive PDF and may be filled out electronically (or by hand). Completing the document and sign, before submitting it in Step 7.
  • STEP 7: Once you’ve completed and signed all remaining forms, you’re ready to upload them. Click the submit button, which will redirect you to the Regional Care, Inc. portal. Click the “Add Files” button, select all the files you want to upload, and click the Open button. Fill in your name, email address, and any comments you want to add in the pop-up window, and click Ok. Then click the Upload button to begin the quick uploading process. A small window will briefly appear at the upper right to notify you when your upload is complete.
  • STEP 8: Your final step is filling out the online application. Simply fill out the form, choose your plan, sign the form electronically, and click submit.
Download Brochure

Employer Freedom Plan
Brochure

Review the Employer Freedom Plan Brochure

Step Two

Submit CoOp Membership
Agreement Here

After completing the CoOp Membership Agreement,
click button above to submit it to the CoOp.

Step Three

AAAHI Member
Information Form

Completed by each new enrolling member

Step Four

AAAHI Member
ACH Recurring Authorization Form

Completed by each enrolling member who
will be paying their own respective premiums.

Step Five

W-9 Form
for AAAHI

Completed for potential return of unused claim dollars.

Step Six

Employer Freedom Plan
Cost Calculator

Completed by each new enrolling member.

Step Seven

Submit Forms
Here

After completing and signing all remaining forms,
click button above to submit them.

Step Eight

Freedom Plan
AAAHI Enrollment Application

Completed by each new enrolling member

Founders of AAAHI

Amy and Scott Newcomer
If you need assistance with enrollment,
please call (303) 261-8022.