best life 

Enrollment Kit - best life (dental & vision)

​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.

 

Our goal is to process your new enrollment easily and efficiently in order to provide you and your client with a quick approval. The following list outlines BEST Life's case submission requirements.

 
  • Completed Employer Enrollment Form - Employer must also sign the Association and Trust Membership Agreement located on the back of the application. Please use corresponding application for corresponding product. 

    • Employer Appli​cation - Dental PPO and​ Vision 

    • Employer A​pplication - Dental Inde​mnityPlus and Vision  

    • Employer Applic​ation - PPO & Access Vision Plans

  • Completed Employee Enrollment Form Include refusal of coverage section or Quick Enroll Census 
    • Employee Enrollment Form - Dental Only  

    • Employee Enrollment Form - Dental Only (Espanol)  

    • Employee Enrollment Form - Dental and Vision 

    • Employee Enrollment Form - Dental and Vision (Espanol) 

    • Employee Enrollment Form - Vision Only 

    • Employee Enrollment Form - Vision Only (Espanol)  

  • Dependent coverage for Domestic Partners:

    • ​If the employer elects coverage for domestic partners, please include a letter from employer 

    • If the employee chooses to insure a domestic partner as a dependent, an "Affidavit of Domestic ​Partnership​" must also be submitted with the employee enrollment form

  • Payroll - Required for all group sizes if company is a spin-off

  • Eligible Owners and Partners - Indicate the names of eligible owners or partners who do not appear on the quarterly wage report and provide owner/partner statements

  • Quarterly Wage Report - No wage report is needed for groups with 5 or more enrolling. For groups of less than 5 enrolling - Indicate on the Quarterly Wage Report which employees are: 

    • FT - Full-time

    • PT - Part-time 

    • S - Seasonal 

    • IE - Ineligible 

    • WP - Waiting for coverage 

    • W - Waiving coverage

  • Proof of Prior Coverage - Submit the most recent invoice indicating the original effective date of coverage

  • Benefit Representative Statement - Located on the back of the employer enrollment form

  • Employer Check - Made payable to "BEST Life and Health Insurance Company" for the first month’s estimated cost

  • Copy of Dental Proposal provided by BEST Life.​

  • Agent Appointment Form and copy of license (if applicable)

  • There is a $20 monthly administration fee for groups with less than 6 employees enrolling for dental.

Licensing: Broker appointment must be completed.  NOTE: The group will not be approved until licensing is received.

 
 
​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.

  • Employee Request for BEST Life Dental (Espanol)
    • BEST Life

    • form # N/A

    • Effective date: 10.01.2018

  • Employee Request for BEST Life Dental
    • BEST Life

    • form # N/A

    • Effective date: 10.01.2018

  • Employee Request for BEST Life Vision (Espanol)
    • BEST Life

    • form # N/A

    • Effective date: 10.01.2018

  • Employee Request for BEST Life Vision
    • BEST Life

    • form # N/A

    • Effective date: 10.01.2018

  • Quick Enroll Census
    • BEST Life

    • form # N/A

    • Effective date: 01.01.2016

  • Affidavit of Domestic Partnership
    • BEST Life

    • form #AFF-DP

    • Effective date: 10.01.2013

  • Employee Enrollment/Change Form - Dental and Vision (Espanol)
    • BEST Life

    • form #DVC0609

    • Effective date: 01.01.2014

  • Employee Enrollment/Change Form - Dental and Vision
    • BEST Life

    • form #DVC1010

    • Effective date: 01.01.2014

  • Employer Application - Dental IndemnityPlus and Vision
    • BEST Life

    • form #IDP0309

    • Effective date: 08.01.2018

  • Employer Application - Dental PPO and Vision
    • BEST Life

    • form #PPO1110

    • Effective date: 08.01.2018

  • Employer Application - PPO & Access Vision Plans
    • BEST Life

    • form #SAV070301

    • Effective date: 08.01.2018

  • New Group Submission Checklist
    • BEST Life

    • form # N/A

    • Effective date: 12.01.2018

  • Agent Appointment Form
    • BEST Life

    • form # N/A

    • Effective date: 01.01.2019