landmark healthplan

Enrollment Kit - landmark (chiro & ACUPUNCTURE)

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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 group enrollment easily and efficiently in order to provide you and your client with a quick approval.  The following list outlines Landmark Healthplan’s case submission requirements.​​​​


Sold Group Paperwork:
  • Group Applicatio​n Form - Eff. 1/1/2020
    • Please be sure to check "Standard" or "Expanded" or both and enter rates for all 4 tiers, even if you do not have enrollment in one or more of the tiers.
  • Landmark Enrollment ​Ce​nsus​ (preferred) or Individual Enr​ollmen​t Forms​ - Effective 1/1/2021
  • Current copy of the group's detail medical billing to verify eligibility or copy of medical ID card for waivers
  • Copy of the binder check. Original should be made out to "Landmark Healthplan of California, Inc."
  • Copy of broker license (first case only)​

 
For other useful or older documents, please refer to the Forms database.