HOW TO SUBMIT A CENTAL CHOICE GROUP

Transcription

1 HOW TO SUBMIT A CENTAL CHOICE GROUP Step 1: Apply for Guarantee to Issue In order for a group to qualify for GTI or Credit for Prior Coverage, you must first submit the New Business GTI Request form to new business. This can be ed to matt@manhattanfl.com or faxed to (904) You will receive a GTI letter outlining the underwriting for your specific group. Remember, your group is not GTI without your GTI Letter in hand. Step 3: Have the Employer Fill out the Premium Payment Agreement Make sure you submit the premium payment agreement prior to your group enrollment. We will issue your group a group number and this will ensure faster processing of the employees policies. Step 4: Submit the Applications Applications will need to be submitted for Central Choice. Please provide a new business transmittal along with them. Applications can be ed to newbusiness@centralchoicegi.com. That s it!!! Nothing Left to do, not even at the Annual Renewal.

2 Date: 11/1/2014 Agent Name: NEW BUSINESS SS GTI REQUEST Please print or type all requested information. Agent Number: Proposed Group Name: Date of Submission: Requested Effective Date: 1. Name of Business Number of Years in Business 2. SIC Code # Full Time Employees # Part Time Employees 3. # of Hours Considered Full-Time Employee? When do Employees Become Eligible for Benefits? Days 4. Does Employer Have Worker s Comp? 5. Employees eligible for sick leave? Throughout Year Days After Hire IF Yes How Much? Annual Enrollment Only Re-enrollment Month? 6. Existing Coverage in Force? 7. Number of Locations and Where Located? Will This Coverage Replace Any Existing Coverage? Insurance Type Replaced? 8. Is this a Section 125 Case?* *Note: DI cannot be Section Method of Premium Remittance Listbill EFT 10. How will applications be transmitted to the Home Office? (Please note, if transmitted electronically, security protocols must be met.) 11. Will the employees or employer be given any written material referencing our policies? If Yes, please submit for approval prior to use, even if it has been approved by us in the past. (Please note, advertising/solicitation materials include any information presented to an employer or employee regarding our rates or products, whether or not our name is used. An employer is consider to be a non-agent and should NOT receive For Agent Use Only material. 12. Takeover? PRODUCTS REQUESTED FOR GTI HOSPTAL INDEMNITY BENEFIT PERIOD DAILY BENEFIT AMT. RIDERS BENEFIT & AMOUNT 0/0 180 Days 1 ST Hospital Confinement Surgical 0/0 365 Days Emergency Accident Surgical Plus 0/3 365 Days Outpatient Sickness Intensive Care Unit ADD Lump Sum Hospital Injury Rider Private Duty Nurse Specified Injury EMPLOYER PD? Yes No % Premium Pd EMPLOYEE PD? Yes No % Premium Pd INDIVIDUAL DISABILITY OCC CLASS REQUESTED MAX BENEFIT ELIMINATION RIDERS BENEFIT AMOUNT Class I BENEFIT AMT* DURATION ACCIDENT SICKNESS 1 ST Hospital Confinement Class II 3 months Emergency Accident Class III 6 months Outpatient Sickness Class Iv 12 months ADD *Benefit amounts in excess of $2,000 are subject to underwriting. 24 months Hospital Indemnity Specified Injury Benefit Builder EMPLOYER PD? Yes No % Premium Pd EMPLOYEE PD? Yes No % Premium Pd Submit Completed Form to: New Business, 1785 Edgewood Ave S, Jacksonville, FL Contact: Matt McKinney matt@manhattanfl.com Telephone: Fax:

3 MANHATTAN LIFE INSURANCE COMPANY FAMILY LIFE INSURANCE COMPANY CENTRAL UNITED LIFE INSURANCE COMPANY INVESTORS CONSOLIDATED INSURANCE COMPANY Northwest Freeway, Houston, Texas or This premium payment agreement is between and. 1. The program is voluntary and may be terminated on written notice of not less than thirty (30) days to the Company, P.O. Box , Houston, TX The minimum requirements to establish and maintain the plan is a monthly billing of $ and three lives. 3. Eligible employees may purchase insurance on their dependents subject to the terms and conditions of the policy. 4. The Company will send or an itemized statement at a date specified by the employer showing premiums due. 5. Premiums will be sent to the Company within 14 days of the receipt of the billing. In doing so, it is understood that the employer is not acting in the capacity as agent. 6. The Company assures the employer that if the employer advances the first monthly premium, it will suffer no loss if any employee applicant terminates before it can deduct the premium from the employee's salary. In this event, the Company agrees to reimburse the employer for the amount of the premium. 7. The Company agrees to provide service to existing and new employees. The Company will contact all new employees (with employer s permission) to discuss this special fringe benefit. 8. Premiums will be deducted Weekly, Monthly, Bi-Monthly, Other(specify). Date initial deductions will begin 9. Premiums will be remitted to the Company Monthly (12 times per year), 13 Pay (13 times per year), 26 Pay (26 times per year), or other). 10. Number of full-time employees (30 hours per week) Please circle the single day of the month you would like to have as the policy effective date and premium due date: Number of days before the policy effective date the bill should be produced (usually a number between 5 and 15 days) days.

4 Are you currently a payroll deduction group with the Company? YES [ ] NO [ ] Requested Group Effective date: Are the premiums to be sheltered under a Cafeteria Plan? YES [ ] NO [ ] If yes, plan date: Select desired sequence of your billings. (Circle only one of these four): A - Alpha by Insured s Name S - Social Security Number E - Numeric by Employee Number P - Numeric by Policy Number For Home Office Use ONLY Group Number Assigned [ ] ] [ ] ] ] ] ] ] ] ] [ ] ] Bill Day Group Number Due Day Company or Group Name Contact Person Address Address City State Zip Code - Phone Fax (Authorized Signature) (Title) (Date) (Agent s Signature) Number (Date) Original To MANHATTAN LIFE/FAMILY LIFE/CENTRAL UNITED/INVESTORS CONSOLIDATED Photocopy or Second Original To EMPLOYER

5 CAFETERIA PLAN (SECTION 125) INFORMATION SHEET Please answer the following questions so we may properly set your account up and not cause any delays in processing. 1. Does your company currently have a Section 125 Cafeteria Plan in place? Yes No (Circle One) (If no, proceed to Number 4.) 2. Our Company s 125 plan year is through. 3. Our open enrollment period is held during the month of. 4. Signature of Officer: Title: Date: Company Name: City: State: Voluntary Group Insurance provided by MANHATTAN LIFE INSURANCE COMPANY FAMILY LIFE INSURANCE COMPANY CENTRAL UNITED LIFE INSURANCE INVESTORS CONSOLIDATED