• Completed Employer Enrollment Form - Employer must also sign the Association and Trust Membership Agreement located on the back of the application. Please use corresponding application for corresponding product.

• Completed 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 with the employee enrollment form

• Payroll - Required for all group sizes if company is a spin-off

• Eligible Owners and Partners - Indicate the names of eligible owners or partners who do not appear on the quarterly wage report and provide owner/partner statements

• Quarterly Wage Report - No wage report is needed for groups with 5 or more enrolling. For groups of 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

• Proof of Prior Coverage - Submit the most recent invoice indicating the original effective date of coverage

• Benefit Representative Statement - Located on the back of the employer enrollment form

• Employer Check - Made payable to "BEST Life and Health Insurance Company" for the first month’s estimated cost

• Copy of Dental Proposal provided by BEST Life.​

• Agent Appointment Form and copy of license (if applicable)

• There is a $20 monthly administration fee for groups with less than 6 employees enrolling for dental.

Licensing: Broker appointment must be completed.  NOTE: The group will not be approved until licensing is received.