American Worker - MVP Health Questionnaire (IHQ)

Enrollment in the Minimum Value Plan (MVP Plan) is dependent on the completion of an Individual Medical Health Questionnaire (IHQ). Employees that have elected the MVP Plan must return a completed IHQ to Fringe Benefit Group within 30 days of electing the plan or enrollment will be cancelled.

Once you have completed the IHQ form, send a copy directly to memberservices@fbg.com and include your first and last name & "Ascen Workforce LLC" in the subject line. For example, "John Doe - Ascen Workforce LLC".

Any misrepresentations, misstatements or omissions of medical information may result in revision of your rates, denial of claims payment or loss of coverage.

All IHQs are reviewed by medical underwriting to determine final rates.