Get Submission Checklist For Medically Underwritten Groups

Filling out the Submission Checklist for Medically Underwritten Groups is an essential step in obtaining the correct insurance coverage for your group. This guide provides a clear and comprehensive set of instructions to help you complete the form accurately and efficiently.

Follow the steps to successfully complete the Submission Checklist.

1. Press the ‘Get Form’ button to access the form and open it in your preferred text editor.
2. Begin with the Group Application, completing Section A by filling in all required fields in their entirety. Ensure accuracy in your entries.
3. Proceed to Section B, the Employer Questionnaire, and provide all necessary information regarding your group.
4. In Section C, the Census, adhere to the following guidelines: For groups with 2 – 24 members, use the provided template. For groups with 25 or more members, an electronic spreadsheet is preferred, listing all employees with names, gender, birth dates, hire dates, coverage types including COBRA participants, and zip codes. Clearly mark employees as ‘ineligible’ or ‘waiving’ if they are not taking coverage.
5. For groups of size 2 – 50, submit a reconciled copy of the most recent quarter’s UC2-A form. Use the provided table to indicate employee employment status accurately, making sure all active employees on the UC2-A match your census.
6. For any covered employees not listed on the UC2-A form, provide appropriate eligibility documents. New hires must submit W-4 forms or recent pay stubs if not listed.
7. Indicate COBRA participants’ names and effective coverage dates at the bottom of the UC2-A form if they are not included in the list.
8. Refer to the Summary of Underwriting Guidelines to confirm eligibility status for employees.
9. Submit the Employee Application/Medical Disclosure Questionnaire, ensuring it is fully completed by each employee or COBRA participant.
10. For each section, all questions must be answered, with detailed explanations for any 'yes' answers in Section D. Ensure all conditions are marked appropriately.
11. Initial and date any changes made in the application, including strikethroughs and white-outs.
12. All attachments must have the employee's signature and date. Ensure the application is signed and dated within 90 days of the effective plan date.
13. If the number of subscribers is less than 50% of the eligible employees, additional documents including the Employee Application/Medical Disclosure Questionnaire and UC2-A/eligibility documents may be necessary.

Complete your forms online today to ensure prompt processing of your medically underwritten group applications.