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.
For New Sponsoring Entity:
For New Enrollee:
- Medical & Rx Enrollment Form - Effective 1/1/2019
Copies of Medicare card for each enrollee (and spouse, if applicable).
First month premium check made payable to “Seniors Choice.” First month's premium is due at time of request for new groups and for add-ons of individually billed groups. Add-ons for individually billed groups must pay via EFT or CC. Seniors Choice will accept a copy of the check to start the process and approve, but the check must be received by the enrollment deadline date. Otherwise, enrollment will be pushed to the next month.
|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.