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Asuris Broker and Agent Communications

03/08/2007   Group set-up process to be improved

We are working diligently to improve our front-end processing of group applications. Our goal is to ensure that your clients are set up in a timely manner and that members receive their member cards by the effective date.

Generally, the 20th day of the month prior to the effective date is the latest date we’d like to receive complete and accurate paperwork for your clients.

We’re asking you to help by submitting the most current applications and forms, by group size, as noted below:

Micro Groups
(2 to 3 Employees)

Community Groups 
(4 to 50 Employees)

Merit & Experience Groups
(51+ Employees)

Group Master Application

Group Master Application

Group Master Application

Benefit Selection Insert

Benefit Selection Insert

Benefit Selection Insert

Employee Enrollment &
Change Form

Employee Enrollment &
Change Form

Employee Enrollment &
Change Form

Waiver Form

Waiver Form

Waiver Form

Domestic Partner Affidavit

Domestic Partner Affidavit

 Domestic Partner Affidavit

We will soon implement a "Delayed Enrollment Exception Request" process. When group enrollment information is received after the 20th day of the month prior to the effective date, your Asuris Sales contact will request that you complete an exception request form. This form addresses the potential group activation delays that may result, including benefit brochures, pharmacy access, member cards and billing statement.

If you have any questions or if you would like to request a printed supply of the applications and forms, please talk with your Asuris Sales contact.

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