Enrollment Kit - simnsa (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 SIMNSA Health Plan’s case submission requirements.
- Name of Group:
- Broker:
- Signed Group Master Application.
- Signed Group Contract.
- Employee Application / Employee Application (Espanol)
- The most recent DE-9C report
- Binder Check (first month’s premium).
- All Ancillary products can only be offered with Medical.
- Broker Licensing: If new broker, signed Solicitor Agreement.
| 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.