This checklist is provided as a guide. The carrier may require additional items and documentation. Please refer to the carrier's underwriting guidelines for a complete list of requirements. Please use the latest version of forms.
LIBERTY DHMO plan options may be offered
dual choice with Ameritas W&B $100 Plus PPO Dental Plan(s). Groups can offer up to two (2) LIBERTY plan(s), with a minimum of two (2) employees in each plan, and minimum of three (3) enrolled in Ameritas PPO plan(s).
NOTE: separate billing
After approval, prior carrier termination letter must be submitted by the employer or broker.
For other useful or older documents, please refer to the Forms database.