|
AR eService Election Form
|
9/6/2009
|
Download
|
|
 |
Census Enrollment Agreement
Description:
Required when submitting enrollment via census
(pdf
, 15k)
|
9/6/2009
|
Download
|
|
|
Census Enrollment Disclosure
Description:
Employer is required to distrib to all employees when enrollment is provided via census
(pdf
, 98k)
|
9/6/2009
|
Download
|
|
|
Census Enrollment Spreadsheet
|
9/6/2009
|
Download
|
|
|
Certification of Common Ownership
|
9/6/2009
|
Download
|
|
|
Electronic Funds Tranfer - Premiums
Description:
For groups that wish electonic premium payment
(pdf
, 183k)
Version: GP47204-3
|
8/3/2010
|
Download
|
|
|
Employer Change Form
|
7/27/2010
|
Download
|
|
|
Employer Change Form
|
7/27/2010
|
Download
|
|
|
eService Election Form
Description:
Oklahoma
(pdf
, 71k)
|
4/16/2003
|
Download
|
|
|
Non-Medical Field Underwriting Memo
Description:
To be used with groups of 5+ enrolled lives in lieu of RAQ or individual health statements
(pdf
, 70k)
Version: GP58978
|
7/22/2010
|
Download
|
|
|
OK Employer Application
Description:
Employer application and amendment form.
(pdf
, 350k)
|
10/12/2009
|
Download
|
|
|
Principal LTD Only W-2 Agreement
|
10/25/2009
|
Download
|
|
|
Principal LTD - STD W-2 & FICA Agreement
|
10/25/2009
|
Download
|
|
|
Principal Online Enrollment Overview
Description:
Provides guidance regarding Principal's online enrollment option as well as instructions for accessing a demo.
(pdf
, 186k)
|
9/29/2009
|
Download
|
|
|
Principal STD W-2 & FICA Agreement
|
10/25/2009
|
Download
|
|
|
Principal STD W-2 Agreement
|
10/25/2009
|
Download
|
|
|
Application to Continue Handicapped Child
|
9/6/2009
|
Download
|
|
|
AR Employee Enrollment without Health Statement
|
9/6/2009
|
Download
|
|
|
OK Employee Change Form
Description:
Oklahoma
(pdf
, 325k)
|
7/27/2010
|
Download
|
|
|
OK Employee Enrollment without Health Statement
Description:
Employee enrollment and/or waiver. Form DOES NOT contain health questions.
(pdf
, 300k)
|
9/6/2009
|
Download
|
|
|
OK Employee Health Statement
Description:
Oklahoma (HIPAA)
(pdf
, 176k)
|
9/6/2009
|
Download
|
|
|
Voluntary Group Life Portibility Form
|
9/6/2009
|
Download
|
|
|
AR Employee Change Form
|
9/6/2009
|
Download
|
|
|
Beneficiary Change Form
Description:
Oklahoma
(pdf
, 185k)
|
6/9/2008
|
Download
|
|
|
Cobra Administrative Guide
Description:
Oklahoma
(pdf
, 141k)
|
5/5/2009
|
Download
|
|
|
Cobra Election Form
Description:
Oklahoma - for accounts with "group" billed cobra.
(pdf
, 210k)
|
5/5/2009
|
Download
|
|
|
Cobra Election Form
Description:
Oklahoma - for accounts with "individual" billed cobra.
(pdf
, 214k)
|
5/5/2009
|
Download
|
|
|
Dependent Student Medical Leave Certification
Description:
Form used to extend coverage for dependent FT student as defined under Michelle's Law
(pdf
, 109k)
|
10/4/2009
|
Download
|
|
|
Oklahoma Continuation 63-Day
Description:
Revised 8-18-10
(pdf
, 92k)
Version: GP46691-03
|
8/18/2010
|
Download
|
|
|
Oklahoma State Continuation - Election Form
|
10/8/2009
|
Download
|
|
|
Disability Claim Form
Description:
For premium waiver, LTD & STD
(pdf
, 250k)
|
1/13/2009
|
Download
|
|
|
Group Life Claim Form
|
6/9/2008
|
Download
|
|
|
Vision Claim Form
|
6/14/2007
|
Download
|
|
|
Deductible Credit Report
|
9/13/2009
|
Download
|
|
|
eService Employee Instruction Brochure
Description:
Instructions for insured to obtain benefit and claim information via internet.
(pdf
, 217k)
|
6/9/2008
|
Download
|
|
|
Master app Checklist
Description:
Assists in completing employer application
(pdf
, 33k)
|
9/6/2009
|
Download
|
|
|
Principal Broker Contact List
Description:
Contacts for medical & non medical claims and administrative issues
(pdf
, 38k)
|
3/11/2010
|
Download
|
|
|
Principal Quote Worksheet
Description:
Broker Guidance - what is need to quote/underwite medical / non med cases
(pdf
, 54k)
|
9/12/2009
|
Download
|
|
|
Refer A Dentist Form
|
9/6/2009
|
Download
|
|
|
Sold Case Submission Checklist
Description:
Assists in completing the case submission process
(doc
, 23k)
|
4/15/2003
|
Download
|
|