• New Case Quote & ExpressEnroll platform request

    This form is used by VIP and our carriers to initiate a case and ensure better preparation for your presentation. The provided information will also be used to create an electronic data cache for easy enrollment (ExpressEnroll). Additionally, it can serve as a closing tool in your presentation. Once built, you will receive the link for your account for convenient use.
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  • Group Client/Prospect Data

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  • Please look at Package 2 of our BeneList. 

    5Star Life's Accident, Hospital with CI, and their Term to age 121 is going to be available where Assurity Products will not. 

    You will need to individually select products for this case rather than select packages but you can refer to your PACKAGE 2 BENELIST for your presentation menu (In grey font/print rather than blue). 

  • BOOM! YOU HAVE SPECIAL VIP UNDERWRITING OFFERED TO YOU CASE. 

     

    With Assurity you have Guaranteed Issue with 2 policies written in each Line of Business offered!

    Minimum of 2 apps per LOB is required*   

    With ASSURITY's LIFE INSURANCE Policies you need the greater of 5 applications or 15% of the amount of employees listed on the Master Application and Assurity's Welcome call.  

    ... if there are 100 or more employees VIP requires the VIP Platinum Underwriting agreement to be signed. You will be redirected to that agreement once this form is completed

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    With 5Star Life you can have 100k in Guarantee Issue in Term to age 121 Life insurance. This includes living benefits in 49 states! 

    Minimum of 5 apps required for the GI*  - Group Size Requirement is 5-100 lives

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    With BEAM Dental/Vision you are eligible for our special offering with no waiting periods, many major services moved to basic (so their copay is less) and no missing tooth clause. There is also a 2 year rate lock with a 3% cap!

    Minimum of 2 apps per LOB*

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    With RECURO Complete you can offer full Virtual Primary Care services with as little as 5 lives for $65/month/FAMILY. 

  • Great Job! Even in a small case, you have incredible underwriting available to your client. 

     

    With Assurity you will simplified issue on CI, Hospital, DI, and Life 

    You will need 2 policies written in each Line of Business offered (life requires more)*  

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    With 5Star Life you can have 100k in Guarantee Issue in Term to age 121 Life insurance. This includes living benefits in 49 states! 

    Minimum of 5 apps required for the GI*  - Group Size Requirement is 5-100 lives

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    With BEAM Dental/Vision you are eligible for our special offering with no waiting periods, many major services moved to basic (so their copay is less) and no missing tooth clause. There is also a 2 year rate lock with a 3% cap!

    Minimum of 2 apps per LOB*

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    With RECURO Complete you can offer full Virtual Primary Care services with as little as 5 lives for $65/month/FAMILY. 

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  • Choose the Packages/Products you would like built for this case.

    This information will go to our carrier's underwriters directly. Afterwards, your Case builder will send you a single, simple email with your proposal(s), Enrollment Link, Google Data Sheet, and QR code included. Average turnaround time is 24 hours.
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  • ATTENTION - As of 3/14/2024 - Sedera Health is not available in California and Illinois due to State Politics and Medical Insurance Mandates. 

  • ATTENTION. You have chosen a package(s) and have elected to add individually selected policies to it/them.

    You do not need to select duplicate products.

    Simply select the policies that you wish to ADD to the packages listed below. 

     

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  • IMPORTANT FOR ICHRA!

    MARKING ICHRA for LS Benefits Group on this form is NOT a Requesst or a referral. This simply gives a notification to them that the possibility is there so they aren't caught by surprise.

    LSBG will not be reaching out to you unless the OFFICIAL Referral request has been completed. 

    You MUST Create an OFFICIAL Request for ICHRA in the LS BENEFITS IMPLEMENTATION PAGE IN YOUR PARTNER APP where a census can be uploaded.  

  • ALMOST DONE. WE NEED A LITTLE MORE INFORMATION.

  • Attention: OneAmerica Quotes

    Phil Corrao will email you and your case builder a proposal containing your chosen options. Please upload the census in the designated space below. If unavailable, email it to phil.corrao@oneamerica.com.


    The census MUST include the following details:

    Employee's Name
    Employee's Date of Birth
    Employee's Salary (if available)
    Employee's Job Title (if available)
    Eligibility: 30+ hours/week only


    This is mandatory for all Colorado PFMLA replacement cases.

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  • Important Notice:

    Carrier quotes will adhere to industry standard monthly billing. This facilitates matching deductions with invoices.
    You are accountable for your payroll deduction reports.

  • A little more more information is needed for Assurity.

  • {writingAgents}.,

    Read this carefully and initial for acknowledgement.

     

    Takeover vs Coexistence definitions:

    Takeover: When we completely replace existing coverage FOR THE ACCOUNT.


    Coexistence: When our coverage exists alongside other providers with like coverage (ie: Assurity AND Aflac  - Accident, CI, Life, Hospital, Disability being simultaneously offered in an account)

    This Underwriting PRIVLIGE (waiver pre-existing conditions and taking on this liability) is for TAKEOVER. Not Coexistance. 

    AT VIP, WE ONLY WAIVE PRE-EX on TAKOVER CASES

    This policy is non-negotiable because:

    It protects the integrity of our underwriting process
    It ensures fair and ethical business practices
    It maintains the quality of our account relationships

    The misuse of our takeover process and Waiver of Pre-Existing Conditions is a serious ethical breach. It not only undermines our underwriting standards but also jeopardizes our relationships with accounts and the integrity of our business model.

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  • Special Circumstances


    Due to the unique circumstances in your case, please reach out to your Executive Partner (Brendan, Brent, Alex, Vanessa, Susan, Rick, or Zach) and inform them of the additional assistance you require.

  • Important Notice

    Please refrain from closing your browser after submitting this form.


    Due to your group size exceeding 100 lives, you must acknowledge the minimum participation requirements for VIP's Platinum underwriting participation standards.
    You will be automatically redirected to the necessary acknowledgment page.

  • Important Reminder

    Please do not close your browser after submitting this form.
    Since you have chosen a custom BEAM DENTAL and VISION quote, you will be redirected to the CUSTOM BEAM DENTAL QUOTE REQUEST page.

  • COLORADO PFMLA... Keep your Browser open after submitting this form. You will be redirected to this quote request page where you can upload your census. 

    Your census will need the following info:

    NAME - GENDER - DOB - TITLE - SALARY

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