Get Group Master Application - Simmons Benefit Group

Filling out the Group Master Application is an essential step for obtaining group coverage through Simmons Benefit Group. This guide provides a clear, step-by-step approach to help users complete the application successfully.

Follow the steps to effectively complete your application online.

1. Click ‘Get Form’ button to obtain the application form and access it for completion.
2. Enter the group's legal name in the designated field. This should reflect the official name of your organization as registered.
3. Select your company structure from the options provided: Sole Proprietorship, Partnership, Corporation, or Other.
4. Provide the Doing Business As (DBA) name, if applicable, as well as the location of your business headquarters.
5. Complete the Employer Federal and State Tax ID numbers. Ensure accuracy to avoid processing issues.
6. Specify the Standard Industrial Classification (SIC) code and provide a brief industry description that describes your organization's activities.
7. Fill in the name and title of the President, Owner, or CEO of the organization.
8. Indicate the primary language used by your group, if it is not English.
9. Enter the physical business address, ensuring that no PO Box numbers are included, followed by the mailing address if it differs.
10. Input your contact information, including the primary phone number, fax number, and the main point of contact's details.
11. In the Primary Group Contact section, provide the name, title, phone number, fax number, and email address of the main contact person for this application.
12. Answer questions regarding other carrier information for medical, dental, pharmacy, and workers' compensation coverages, including ending dates where necessary.
13. Complete the agent information section by providing the agency’s name, agent details, and any commission split information if applicable.
14. Proceed to the billing section and specify whether separate billing invoices are required, alongside detailing billing locations.
15. Fill out the federal mandates section by indicating your group's obligations under COBRA, OBRA, TEFRA/DEFRA, and ERISA.
16. Continue to the eligibility information for both group and employee eligibility sections, ensuring accurate counts of eligible employees and classifications.
17. Complete the employer contribution section by specifying the payment percentages towards medical and dental coverages.
18. In the group participation section, provide all hire and waiver details necessary for the application.
19. Review and acknowledge the acknowledgments and certifications section, ensuring all statements are complete and correct.
20. Finally, have an authorized representative sign, provide their title, and date the application before submitting it.

Complete your application online to ensure timely processing and coverage activation.