What do I need to submit with a new group?

June 25, 2015

The following information is required when submitting a new group application for benefits:

  • Group Application
  • Company check (for first month’s premium)
  • Employee enrollment forms
  • Proof of prior coverage (not applicable for Co-pay and Discount plans)
  • Summary of benefits from prior plan
  • Last month’s invoice from prior plan
  • Employee effective dates on prior plan
  • Census (Contributory plans & Voluntary Indemnity plans (Utah & Texas) or PPO plans (Utah only) with less than 5 enrolled)
  • Waiver enrollment forms (Contributory plans only)


For your convenience, a New Group Submittal Checklist is available under Forms.