Enrollment Kit - Seniors Choice (Medical)
X
0
Forms Selected
Clear Selection
Form Name
Effective Date
Current As Of
"Current As Of" signifies the latest date on which a Word & Brown
Team Member confirmed that the Forms/Document available for download represents the most up-to-date and recently
revised version accessible.
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 Seniors Choice’s case submission requirements.
- For New Sponsoring Entity:
- Employer Trust Agreement - GTL - Effective 1/1/2021
- Supporting Business Entity Documentation (Depending on Entity Type – Specifications are listed on the Employer Trust Agreement and in the Eligibility Guidelines).
- For New Enrollee:
- Medical & Rx Enrollment Form - Effective 1/1/2021
- Copies of Medicare card for each enrollee (and spouse, if applicable).
- 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. Add-ons for individually billed groups must pay via EFT or CC. Seniors Choice will accept a copy of the check to start the process and approve, but the check must be received by the enrollment deadline date. Otherwise, enrollment will be pushed to the next month.
| 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.