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 MetLife's case submission requests.
- Specialty Market New Group Submission Form*
- DPPO Group Application* – (PPO Dental, Life and Disability, Vision)
- DHMO Group Application (if applicable)
- E-Census or Employee Enrollment Forms*
- Copy of Signed Proposal* - Please include entire proposal (rates and benefits)
- Non Standard Commission Agreement or Standard Commission Agreement (if applicable)
- AXA Travel Assistance Agreement (Required for Supplemental Life Only)
- HIPAA Request Document (included in Broker Compensation and Customer Privacy Notices packet)
- Broker Compensation and Customer Privacy Notices
- Statement of Responsibility (Required for groups with 100+ eligible lives)
- Binder Check (Not required for TPA submissions, add-coverages, or contributory coverages where employees’ contribution is 50% or more)
* indicates the document is required with all submissions
PPO Dental, Life, Vision, Disability – Please submit all completed forms no later than the 5th business day following the requested effective date. Cases submitted after the 5th business day will go through a late submission review for an exception.
DHMO – Please submit all completed forms no later than the 10th (off peak season) and the 5th (peak season) of the month prior to the
effective date. No exceptions. Employees must be added to the provider’s dental roster prior to the effective date of coverage.
Steps for Submitting Business:
1. Complete the required forms mentioned above
2. Scan and email all completed forms to firstname.lastname@example.org