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Single Employer Trust (SET) Program Forms
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| Click on the form name for a printable PDF version. |
| • Employer-Sponsor Application |
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| • Employee Enrollment Application (25-49 emp) |
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| • Medical Claim Form |
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| • Employee Enrollment Application (50+ emp) |
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American Benefit Administrative Services, Inc. / Third Party Administrators, Inc. |
1733 Park Street, Suite 300
Naperville, Illinois 60563
630-416-1111 • 800-736-7872 • Fax: 630-416-9310
© 2010 American Benefit Administrative Services, Inc. / Third Party Administrators, Inc.
Naperville, Illinois 60563
630-416-1111 • 800-736-7872 • Fax: 630-416-9310
© 2010 American Benefit Administrative Services, Inc. / Third Party Administrators, Inc.