We have prepared this interactive Group Enrollment Guide to acquaint you with the forms associated with the submission and enrollment of a new group. Should you have any questions, please call Group Marketing at 1-800-753-0404. You may order brochures and forms by e-mail, supplies@companiongroup.com. Simply indicate the form name, form number and quantity desired. Don't forget to include your complete mailing address, including ZIP code. Use our convenient census enrollment option! Group Coverage Employer Application Employee Enrollment Form Small Group Products Companion Business Plan Life & STD - (2-9 Lives) Form # 95074 (Rev. 11/07) Rate Information Brochure Form # 95074 Rates (Rev. 11/07) Employer Part App for the Joint Employer Grp Ins Trust Form #95082 (Rev. 12/07) Group Insurance Enrollment Form Form #95206 (Rev.9/06) Group Insurance Health Statement Form #97001 (Rev. 1/07) Companion Business Plan LTD - (2-9 Lives) Form #95995 (2/04) (Available to grps of 6-9 employees in SC and PA) Employer Part App for the Joint Employer Grp Ins Trust Form #95997 (10/05) Group Insurance Enrollment Form Form #95206 (Rev.9/06) Group Insurance Health Statement Form #97001 (Rev. 1/07) Dental "Cents" Brochure Form #95067 (Rev. 12/06) Rate Information Brochure Form #95076 (Rev. 10/07) Takeover benefits available Dental Employer Participation App for the Joint Employer Grp Ins Trust Form #95078 (Rev.10/04) (in Dtl Rate Brochure) Group Insurance Enrollment Form Form #95206 (Rev.9/06) Large Group Products True Group Life, AD & D, STD and LTD Brochure Form #95221 (Rev. 12/06) Group Application Form #11383 (Rev. 12/06) Group Insurance Enrollment Form Form #95206 (Rev.9/06) Group Insurance Health Statement Form #97001 (Rev. 1/07) Dental by Design Product Brochure Form #95177 (Rev. 10/07) Employer Application Form Group Dental Insurance Form #95187 (4/07) Group Insurance Enrollment Form Form #95206 (Rev.9/06) Vision by Design Product Brochure Form #95283 (Rev.6/07) Employer Application for Group Vision Insurance Form #95224 (Rev. 11/05) Note: Oregon, South Dakota and West Virginia - Use Form # 95275 (Rev. 11/05) Group Insurance Enrollment Form Form #95206 (Rev.9/06) Voluntary Products Voluntary Dental #95970 (11/07) Rate Information Brochure #95972 (Rev. 11/07) Voluntary Dental MAC Rates #95296 (Rev. 11/07) Takeover benefits available Voluntary Dental Ins Employer App Form #95990 (10/05) Group Insurance Enrollment Form Form #95206 (Rev.9/06) Voluntary Group Term Life Brochure - Voluntary Life 95975 (8/07) with Rate Sheet (7/07) Voluntary Group Term Life Ins. Employer Participation App. Form # VGTL 803 (3/04) Group Insurance Enrollment Form Form #95206 (Rev.9/06) Group Insurance Health Statement Form #97001 (Rev. 1/07) Voluntary LTD Form #95967 (8/06) Group Application Form #11383 (Rev. 12/06) Group Insurance Enrollment Form Form #95206 (Rev.9/06) Group Insurance Health Statement Form #97001 (Rev. 1/07) Voluntary STD Form #95960 (12/07) Group Application Form #11383 (Rev. 12/06) Voluntary Short Term Disability Employee Enrollment Form Form #95982 (Rev. 3/08) Voluntary Short Term Disability Employee Enrollment Form - Buy-Up Plan Form #95982 Buy-Up (Rev. 3/08) Voluntary Short Term Disability Employee Enrollment Form - Two Option Form Form #95982 Two Option (Rev. 3/08) Vision by Design Product Brochure Form #95283 (Rev.6/07) Employer Application for Group Vision Insurance Form #95224 (Rev. 11/05) Note: Oregon, South Dakota and West Virginia - Use Form # 95275 (Rev. 11/05) Group Insurance Enrollment Form Form #95206 (Rev.9/06) "Roster Census" enrollment may be acceptable for certain True Group life, STD, LTD and dental plans. Please coordinate with Underwriting prior to enrolling a group. To ensure maximum accuracy and quickest service, we recommend that a New Business Processing Form #95988 accompany each sold case. *Replacing Group Coverage/Takeover Benefits - If this plan is replacing group coverage, include a copy of the most recent premium statement of the current carrier, listing names of the participants (including their effective dates of coverage). Include a copy of the current Dental certificate booklet. If the prior carrier's bill does not include the effective date of coverage, please note this information next to each employee's name so we can give the correct credit for transfer of benefits. (Current dental plan must have been in effect continuously for at least 12 months prior to the effective date of this plan. Please see your brochure for details). 95084 (Rev. 3/08)
Group Coverage
Employer Application
Employee Enrollment Form
Small Group Products
Companion Business Plan Life & STD - (2-9 Lives)
Form # 95074 (Rev. 11/07)
Rate Information Brochure
Form # 95074 Rates (Rev. 11/07)
Employer Part App for the Joint Employer Grp Ins Trust Form #95082 (Rev. 12/07)
Group Insurance Enrollment Form Form #95206 (Rev.9/06)
Group Insurance Health Statement
Form #97001 (Rev. 1/07)
Companion Business Plan LTD - (2-9 Lives) Form #95995 (2/04)
(Available to grps of 6-9 employees in SC and PA)
Employer Part App for the Joint Employer Grp Ins Trust Form #95997 (10/05)
Dental "Cents" Brochure Form #95067 (Rev. 12/06) Rate Information Brochure Form #95076 (Rev. 10/07) Takeover benefits available
Dental Employer Participation App for the Joint Employer Grp Ins Trust Form #95078 (Rev.10/04) (in Dtl Rate Brochure)
Large Group Products
True Group Life, AD & D, STD and LTD Brochure Form #95221 (Rev. 12/06)
Group Application Form #11383 (Rev. 12/06)
Dental by Design Product Brochure Form #95177 (Rev. 10/07)
Employer Application Form Group Dental Insurance Form #95187 (4/07)
Form #95283 (Rev.6/07)
Employer Application for Group Vision Insurance
Note: Oregon, South Dakota and West Virginia - Use Form # 95275 (Rev. 11/05)
Voluntary Products
Voluntary Dental #95970 (11/07)
Voluntary Dental MAC Rates
Takeover benefits available
Voluntary Dental Ins Employer App Form #95990 (10/05)
Voluntary Group Term Life Brochure - Voluntary Life 95975 (8/07) with Rate Sheet (7/07)
Voluntary Group Term Life Ins. Employer Participation App. Form # VGTL 803 (3/04)
Voluntary LTD Form #95967 (8/06)
Group Insurance Enrollment Form Form #95206 (Rev.9/06) Group Insurance Health Statement
Voluntary STD Form #95960 (12/07)
Voluntary Short Term Disability Employee Enrollment Form Form #95982 (Rev. 3/08)
Voluntary Short Term Disability Employee Enrollment Form -
Buy-Up Plan
Form #95982 Buy-Up (Rev. 3/08)
Two Option Form
Form #95982 Two Option (Rev. 3/08)
"Roster Census" enrollment may be acceptable for certain True Group life, STD, LTD and dental plans. Please coordinate with Underwriting prior to enrolling a group.
To ensure maximum accuracy and quickest service, we recommend that a New Business Processing Form #95988 accompany each sold case.
*Replacing Group Coverage/Takeover Benefits - If this plan is replacing group coverage, include a copy of the most recent premium statement of the current carrier, listing names of the participants (including their effective dates of coverage). Include a copy of the current Dental certificate booklet. If the prior carrier's bill does not include the effective date of coverage, please note this information next to each employee's name so we can give the correct credit for transfer of benefits. (Current dental plan must have been in effect continuously for at least 12 months prior to the effective date of this plan. Please see your brochure for details). 95084 (Rev. 3/08)