Dear :

The attached files are the forms that are required to setup a Baylor Scott and White group policy:

Group Employer Data Form: The Group Employer Data Form is where you provide the basic company information in the top section and select which company paperwork will be submitted to prove that the company can qualify for group coverage. Be sure to include copies of the documents that are checked on this form. Answer all of the questions concerning the waiting period, employer contribution, payment method and requested effective date.

Employer Application: If the group is electing PPO plans for their employees, they elect the PPO Employer application. If the group is electing HMO plans for the employees, they use the HMO Employer Application. Groups can elect both PPO and HMO plans for employee offering. If offering both networks, both forms must be completed. Employees will complete either the PPO or HMO enrollment form depending upon the coverage offered and what type plan they want to enroll in for the effective date.

Employer Request for Interactive Services: This form is to identify who can access the Employer information on-line to add/term employees, etc. This is usually the employer contact person responsible for enrollment and can also be the agent or agency that is writing the group.

Producer Commission Form: This form is included with each group submission.

Please complete these forms as best you can, making sure to sign and date in the appropriate areas. Also provide copies of the documents that are selected on the Group Employer Data Form. Each full-time employee must complete an enrollment form either electing the group coverage or waiving the group coverage.

All of the documents above can be scanned and emailed back to us through our secure email system or faxed to us at .

Please don’t hesitate to call/email, if you have any questions/concerns. If the agent you are working with is not available when you call, please ask to speak to any other agent so your question(s) can quickly be answered. This helps to reduce time wasted with phone tag. We do want to try and get all paperwork completed as soon as possible and submitted to us no later than 10 days prior to the requested effective date to insure that you have your policy and ID cards.

Thank you for working with us and have a great day.

Documents to Include:

Open and save these documents, then attach them to the email.