Account Management

Kansas
Additional Forms and Resources

Disabled Dependent Form

Group Information Update Form

Group Information Update Form

HIPPA Disclosure Form

Kansas Statement of Insurability

Life/AD&D/Disability Admin Forms

Medical Administration Guide

Medical Claim Reimbursement

New Business Enrollment Spreadsheet

New Member Checklist

Prescription Reimbursement Form

Licensing, Credentialing and Compensation

Agent Compensation Form

New Broker Appointment Form

Producer Performance Guide

Agent of Record Change Guidelines: Groups 2-99

Agent of Record Change Letter

Employer eService

Broker Service Team Contact Flier

Employer eService Policy Add Form

United eService

Delegation Management for Agency Admins

Delegation Management for Delegates

UeS Agency Admin Update Form
Northwest Missouri
Additional Forms and Resources

Disabled Dependent Form

Group Information Update Form

Group Information Update Form

HIPPA Disclosure Form

Life/AD&D/Disability Admin Forms

Medical Administration Guide

Medical Claim Reimbursement

Missouri Statement of Insurability

New Business Enrollment Spreadsheet

New Member Checklist

Prescription Reimbursement Form

Agent of Record Change Guidelines: Groups 2-50

Agent of Record Change Letter

Agent of Record Change Guidelines: Groups 51-99

51+ Billing and Service Fee Agreement Checklist

Agent of Record Change Letter

Billing Collection Agreement

*All Agent of Record change requests for Missouri based accounts with 51-99 employees require an Agent of Record Change Letter AND 51+ Billing and Service Agreement Form.

Employer eService

Broker Service Team Contact Flier

Employer eService Policy Add Form

United eService

Delegation Management for Agency Admins

Delegation Management for Delegates

UeS Agency Admin Update Form
Licensing, Credentialing and Compensation

Agent Compensation Form

New Broker Appointment Form

Producer Performance Guide