reliance standard

Enrollment Kit - reliance standard (dental)



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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 Reliance Standard’s case submission requirements.​​
  • Completed SmartChoice Request for Participation a​nd Enrollment Form​​ (2-19 lives).
  • Copy of sold proposal premium summary page(s) as presented to the employer (2+ lives).
  • SmartChoice Employee Enrollment Forms​.
    • To write a (2) employee dental group, two additional lines of coverage must also be sold.

If applicable:
  • Notification of Waiver Form(s)​​​ (2-19 lives)
  • Quarterly State Wage Reports may be requested at the discretion of Reliance Standard (2-19 lives)
  • Prior carrier information required for Dental, STD and LTD coverage takeover (2+ lives)
  • Evidence of Insurability Applications for Life benefits exceeding Non-Medical Issue (Guaranteed Issue Amount) Limits (2+ lives).

NOTE:  If any of the above items are missing or incomplete, processing of case may be delayed.
  • Broker Licensing: Agent Appointment Application and Commission Schedule​ and copy of license (if applicable).
  • Authorization Agreement for Automatic Deposits​​ of Commission​
  • EFT Recurring Payment Authorization
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.