CO Carrier Case Submission Requirements

Case Submissions
COLORADO
Aetna ACA
Aetna AFA
Ameritas
Assurant
Avesis
Delta Dental
Dental Select
Friday Health
Plans
Guardian
Hartford Life
Humana
Humana
Level Funded
Kaiser
Permanente
MetLife
National
General
One America
Principal
Reliance
Standard
Unum
VSP
Quote / Proposal 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Approval / Welcome Letter 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Employer Application 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Member Applications 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Census Enrollment Spreadsheet 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4 4
Waivers 4 4 4 4 4 4 4 4 4 4 4 4 4
Legal Documents / State-Filed
Proof of Business
4
EFT/ACH Form or Live Check Copy 4 4 4 4 4 4 4
Quarterly Wage Report 4 4 4
Payroll 4 4 4
Prior Carrier Bill 4 4 4 4 4 4 4 4 4 4 4 4
POP Section 125 App/Check 4 4
Attestation Form 4 4
Supplemental Employment
Verification Form
COBRA / State Continuation Form 4
NPOS / HMO Disclosure 4 4
Small Group Certification Form
Stop Loss Form 4 4
AHIA Form 4
Data Software Licensing Agreement 4
NY-HCRA Form 4
Proof of Eligibility Form 4
COBRA Agreement Form 4
Evidence of Insurability Form /
Health Questionnaire
4 4 4 4 4 4 4
W-2 Agreement
Actively at Work Form 4
New Business Sold Case Checklist 4
Carrier Website Authorization Form 4 4 4
AXA Travel Assistance Agreement 4
Commission Agreement 4
Common Ownership Form 4 4
PHI Release Form
Final Rates 4
4
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20181029A.1809 CO