Enrollment Kit - BEST Life (Dental & Vision)
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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 BEST Life’s case submission requirements.
- Employer Enrollment Form – Employer must also sign the Association and Trust Membership Agreement located on the back of the form.
- Employee Enrollment Form or Group Enrollment Roster - Include refusal of coverage section.
- Dependent coverage for Domestic Partners:
- If the employer elects coverage for domestic partners, please include a letter from employer.
- If the employee chooses to insure a domestic partner as a dependent, an Affidavit of Domestic Partnership must also be submitted along with th employee enrollment form.
- Payroll - Required for all group sizes if company is a spin-off.
- Eligible Owners and Partners - Indicate the names of the eligible owners or partners who do not appear on the quarterly wage report and provide owner/partners statements.
- Quarterly Wage Report – No wage report is needed for groups with 5 or more enrolling.
- For groups less than 5 enrolling - Indicate on the quarterly wage report which employees are:
- FT - Full-time
- PT - Part-time
- S - Seasonal
- IE - Ineligible
- WP - Waiting for Coverage
- W - Waiving coverage
- For groups less than 5 enrolling - Indicate on the quarterly wage report which employees are:
- Proof of Prior Coverage – Submit the most recent invoice indicating the original effective date of coverage.
- Benefit Representative Statement - Located on the back of Employer Enrollment Form.
- Employer Check - Made payable to “BEST Life and Health Company” for the first month’s estimated cost.
- Copy of Dental Proposal.
- There is a $20 monthly administration fee for groups with less than 6 employees enrolling for dental.
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.