Forms and Resources


Listed below are all the forms that you may need access to. Should you have any questions regarding a form, please feel free to contact your AultCare Representative.




Administration Manuals

Insured Manual
  • Welcome to AultCare
    Welcome to AultCare, Employer Registration Guide, File Retrieval Guide and Blue Button Website Information.
  • Insured Enrollment Information
    Enrollment Information, Membership Report Claim, EOB Guide, Invoices, Enrollee Questionnaire Forms, and Application Form Example.
  • Explanation of Benefits and Appeal Documents
    Member Letter, Request for Review by the Ohio Department of Insurance, AultCare Treating Physician Certification for Experimental ABD, AultCare Treating Physician Certification for Internal Appeal Review, External Review Procedures Summary, External Review Request Form, and Internal Appeal Request Form.
  • Summary of Benefits Examples
    Example of Summary of Benefits for plans.
  • Urgent Care, Aultline, RxEOB Pharmacy and More
    Network Locations for Urgent Care and After Hours Care, Aultline to Assist Members Day or Night, RxEOB Personalized Prescription Information Website, and Find out How to Get the Most from Your Health Care.