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Agent Forms:

All Forms

 

Applications

Underwriting

  • Merit Group Request for Proposal
    This form is completed by Sales Representatives and District Sales Managers with the group's insurance information. This will prompt the Underwriting work area to produce a quote.
  • Small Group Worksheet
    Sales Represesentatives and District Sales Managers complete the Small Group Worksheet, which must be attached to the customer's employee health statements. The Employer Group Listing is provided to the Underwriting work area to produce a quote.
  • UW15A- Potential Employer Contribution Form 1
  • UW15B - Potential Employer Contribution Form 2
  • UW Release for Medical Records

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