Agent Needed Documents

 

 Statz and Associates Forms:

Individual Applications and Forms:

Individual Quote Request Fill-In Form

Individual Quote Request Paper Form

Aetna Individual Application

Anthem Individual Application

Golden Rule Individual Application

Medical Mutual Individual Application

Group Forms: 

 Agent Change of Record Form Please have client fill in carrier, policy number, effective date, and have group controller or president sign the letter on Company Letterhead

Terminate Employee from Group Form

Terminate Dependent from Employee Policy Form

Terminate Group Policy

Terminate Individual Coverage Form

Small Group Quoting Checklist

Health Questionnaire for 2- 50 Lives

Small Group Submission Checklist

Large Group Quoting Checklist

Large Group Health Questionnaire

Employer Risk Assesment

Shock Claim Form

 Carrier Plan Designs and Applications:

 CompDent Individual Dental Application and Directory Packet

Aetna Employee Application

Aetna Employer Application

Aetna Medicare Carve Out Employer Application

Aetna Medicare Carve Out Employee Application

 

 

Anthem Premier Benefit Description

 

Anthem SmartSense Benefit Description

Anthem Group Benefit Designs

Anthem Employer Application

Anthem Employee Application/Change Form

Atlas Global Travel Application for Individuals

Atlas Global Travel Application for Groups

Cose Employee Application/Change Form

Cose Employee Application Change Form 20 +

Cose Employer Application

Cose Multiple Option Plans

Cose 2080 Plans

Cose High Deductible Options

Cose HSA Options

Kaiser Individual Rates for 2009

Kaiser Deductible Plans 2009 Individual

Kaiser Co Insurance Plans 2009 Individual

Kaiser Employee Enrollment Form

Medical Mutual No CoPay Plans 500/1000/1500 Individual

Medical Mutual No CoPay Plans 2500/5000/10000 Individual

Medical Mutual Individual CoPay Plans Individual

Medical Mutual SuperDent 180 Plan Description Group

Medical Mutual 20+ Employees Application/Change Form

Medical Mutual Application Employees 2-19

Medical Mutual Employer Contract

Medical Mutual Employer Application

Medical Mutual High Deductible Plan Designs for Groups

SummaCare Plan Designs

SummaCare Employer Application

SummaCare Employee Application

United Health Care Employer Application

United Health Care Employee Application 2-9

United Health Care Employee Application 10-99