Get Obmgrup

This guide provides a comprehensive overview of filling out the Obmgrup form online. Completing this enrollment checklist will ensure a smooth process for enrolling a new group into an OBM plan.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Fill in the required fields at the top of the form, which include the full legal group name, requested effective date, primary contact, and corresponding contact details such as phone number and email.
3. Complete the group address section by providing the complete address including city, state, and zip code.
4. Indicate the nature of the business and the corresponding Standard Industry Classification (SIC) code. Select the business type from the provided options.
5. Submit the required documents listed in the guidelines, including a completed Group Enrollment Checklist, a binder check, a rate sheet, Wage and Tax Statement, and current dental insurance carrier's Summary of Benefits.
6. Answer the questions regarding the company's tax ID, ERISA status, and prior dental coverage history.
7. Fill out the participation section, indicating total employees, eligible employees, and those enrolling, ensuring that participation levels meet OBM's requirements.
8. Select the appropriate plan option from the provided choices and fill in the broker information if applicable.
9. After completing the form, review all entries for accuracy and then choose to save your changes, download, print, or share the form as needed.

Complete your OBM enrollment checklist online today to ensure your group is enrolled smoothly.