What documentation is necessary for enrolling a group?
The following are guidelines for required documentation when submitting new business: • A copy of the agent’s quite (based on final enrollment) • Small Group Employer Application (Master Application) • Applications from all enrolling employees/dependents • Applications from all employees/dependents declining coverage (sections 2&4 of the Employee Application must be completed) • Copy of the company’s most recent State Employer’s Quarterly Report (provide current employment status for all employees listed) • If this is a takeover submission, a copy of the last month’s group premium statement • COBRA/FMLA Questionnaire (if applicable) • A company check for the first months medical, dental and life premium payable to UNICARE Life & Health Insurance Company or UNICARE Health Insurance Company of the Midwest • Submit 100% of the premium with the applications
• Master Application • Individual Applications including Refusal Applications • Handicap/Disabled Member Certification Form • Medical Questionnaires • Single Case Commission Agreement • Copy of Prior Carrier’s Bill • Benefit Booklet • Signed Group Assessment and Rate Request Form • Certification of Dependency Form for foster children applying for coverage
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- What documentation is necessary for enrolling a group?
