Employee Benefit Plans - BEN-E-LECT

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Forms
Ease and simplicity are two key points in streamlining your time. Because we know and understand this, we have designed our forms to be functional and efficient. In this section you will see everything from enrollment forms and marketing material to broker kits.

Employer Application

Employee Enrollment

Freedom Plan Rates - Arizona

Freedom Plan Rates - California

Freedom Plan Rates - Colorado

Employer Application - Colorado

Employee Enrollment - Colorado

Freedom Plan Rates - Idaho

Freedom Plan Rates - Nevada

Employer Application - Nevada

Employee Enrollment - Nevada

Freedom Plan Rates - Texas

Freedom Plan Rates - Utah

Forms to enroll a group
with a new carrier

Benefit Authorization Standard

Group Release Form for Ben-e-lect

Forms pertaining to a Medical plan

Employee Application

Benefit Authorization Standard

Agent Benefit Authorization

Employer Benefit Authorization

Benefit Authorization HRA

Benefit Authorization HSA

Benefit Authorization Mix n Match

Benefit Authorization Basic PPO

Funding Options

Rollover - What to expect

Section 125 Proposal

Employer Packet

Password Request Form

Services Required of a TPA

Forms for a group changing plans within a carrier

Benefit Authorization Standard

Employer Application

Employee Application

Employer Benefit Authorization

Dental Guidelines

Billing, Administration, Commissions

Sample Plan Design - $250 deductible

Sample Plan Design - $500 deductible

Employer Application

Employee Application

Dental Guidelines

Billing, Administration, Commissions

Sample EOBs from different carriers

Aetna
Ben-e-lect
Blue Cross

Blue Shield
Health Net
Nationwide

Pacificare

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