seniors choice

Enrollment Kit - seniors choice (medical)

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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 Senior Choice's case submission requirements. 
 
 
For New Sponsoring Entity 
  • Employer Trust Agreement (with physical address) 
  • Supporting Business Entity Documentation (Depending on Entity Type - Specifications are listed on the Employer Trust Participation Agreement and in the Eligibility Guidelines​)​
 
For New Enrollee 
  • ​​Enrollment Application (with physical address) 
  • Copies of Medicare card for each enrollee (and spouse, if applicable). Must have both Medicare Parts A & B. Will accept letter from SSA showing applied. 
  • ​First month premium check made payable to: "Seniors Choice." First month's premium is due at time of request for new groups and for add-ons of individually billed groups. We will accept a copy of the check to start the process and approve, but the check must be received by the enrollment deadline date (5th of the month for the requested enrollment date). Otherwise, enrollment will be pushed to the next month. 
  • A complete case must be submitted by Noon (MST) of the deadline each month. An incomplete case (any missing information) will roll to the next effective date. 
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.