Health Industry Collaboration Effort

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Looking for a final HICE document/template? They can be found in the Final HICE Documents folder - click here for a list of available documents for each HICE team: FINAL HICE DOCUMENTS.

Health Plan Specific Letter Templates
Health Plan Specific Letter Templates
01_Template Instructions
Participating health plans that have confirmed the templates have been reviewed to determine regulatory compliance are able to use a self-service web-based tool to upload their health plan-specific templates to this site. Please contact the plans directly for any templates not available on the HICE website. To receive broadcast messages when letter templates are added/updated by participating plans, add the "Health Plan Specific Letter Template Notifications" Team to your HICE account (see Teams" page for instructions on how to do this or contact admin@iceforhealth.org if assistance is needed).
Aetna
Anthem Blue Cross
Cigna
Clever Care Health Plan
Elite Health Plan
		File	Upload	Review
	Title	Size	Date	Date
	Elite Health Plan _UM_ Medicare HMO_Auth_Approval_Letter English 1-28-2026	29 KB	2/5/2026
	Elite Health Plan _UM_ Medicare HMO_Auth_Approval_Letter Spanish 1-28-2026	14 KB	2/5/2026
	Elite Health Plan NDMC Notice of Denial of Medical Coverage Denied English 1-28-2026	40 KB	2/5/2026
	Elite Health Plan NDMC Notice of Denial of Medical Coverage Denied Spanish 1-28-2026	20 KB	2/5/2026
	Elite Health Plan UM Reinstatement letter English 1-28-2026	24 KB	2/5/2026
	Elite Health Plan UM Reinstatement letter Spanish 1-28-2026	24 KB	2/5/2026
	Elite Health Plan_Exh_UM_Medicare Carve Out Member_Review and Approve_English 1-28-2026	23 KB	2/5/2026
	Elite Health Plan_Exh_UM_Medicare Carve Out Member_Review and Approve_Spanish 1-28-2026	24 KB	2/5/2026
	Elite Health Plan UM_Dismissal_Coverage_Request_Provider_English_1-28-2026	44 KB	2/5/2026
	Elite Health Plan UM_Dismissal_Coverage_Request_Provider_Spanish_1-28-2026	44 KB	2/5/2026
	Elite Health Plan_NOMNC_Notice of Medicare Non Coverage_English 1-28-2026	38 KB	2/5/2026
	Elite Health Plan_NOMNC_Notice of Medicare Non Coverage_Spanish 1-28-2026	38 KB	2/5/2026
	Elite Health Plan_UM_Medicare HMO_DENC_Letter English1-28-2026	37 KB	2/5/2026
	Elite Health Plan_UM_Medicare HMO_DENC_Letter Spanish1-28-2026	38 KB	2/5/2026
	Elite_Health_Plan_Non_Discrimination_English_9_2025_508	196 KB	2/5/2026
	Elite_Health_Plan_Non_Discrimination_Spanish_9_2025_508	176 KB	2/5/2026
	Elite_Health_Plan_Notice_of_Availability_8_18_2025_508	663 KB	2/5/2026
	Elite_Health_Plan_Non_Discrimination_English_9_2025_508	196 KB	2/5/2026
	Elite_Health_Plan_Non_Discrimination_Spanish_9_2025_508	176 KB	2/5/2026
Health Net
Sharp Health Plan
Test

HICE documents can be altered for use by organizations/other regions as needed; however, the HICE logo/any HICE references should be removed if the document is not being used in its original format. Documents available within the Library are intended to be used as printed documents. To the extent such documents are used digitally, it shall be the user's responsibility to ensure their use of the documents adheres to the accessibility standards applicable to their organization.

HICE is a voluntary 501(c)3 organization that includes participation by and advice from accrediting and regulatory agencies. The goal of HICE work products is to offer HICE participating organizations standardized tools and best practices toward optimizing efficiencies to implement health industry requirements. HICE heeds feedback from accrediting and regulatory agency partners regarding HICE work products; however, HICE does not obtain official regulatory approval for its work products. As such, HICE work products are not to be considered exempt from any approval process required by regulatory agencies.