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.
- Employer Application: The application should be completed and signed by the client and the broker.
- Employee Applications and Waivers: An enrollment application or waiver form from all employees eligible for coverage. Waivers must comply to minimum participation requirements.
- Deposit: A check from the employer that will be applied to the first month's premium.
- Prior Carrier's Billing Statement: A copy of the most recent billing statement from the prior carrier, if there is prior coverage.
- COBRA Information: A list of all former employees/depenedents on COBRA which includes the qualifying event reason and qualifying date of COBRA coverage, plus a copy of the COBRA election statement(s).
- State Wage and Tax Withholding Statement (DE-9C): For groups with 50 or fewer eligible employees, a copy of the employer's most recent quarterly statement is required.
- Broker Agreement
- Business Associate Agreement
|After approval, prior carrier termination letter must be submitted by the employer or broker.|
For other useful and older documents, please refer to the Forms database.