Enrollment Kit as One File

Enrollment Kit as Separate Forms

Additional Forms NOT Included in the Kit

Plan Changes for In-Force Groups

Benefit Plan Selection Forms: Please contact the Group Service Team at 847.605.1200 to get details on when plan changes are allowed and paperwork is due.

Billing Method Form Only needed if your group is changing their billing method. Example: If they are currently Age Rated and are staying Age rated, there is no need to fill out this form.

Employee Application will be required for any employees changing plans or joining during open enrollment. If they are an existing member or not on an ACA Metallic plan the medical questions are not required.

Prescription Drug Forms

Administrative Forms for In-Force Groups

Resource Brokerage

1501 East Woodfield Road, Ste 110e
Schaumburg, IL 60173
Toll Free: 1-800-605-7566
General Phone: (847) 605-1200

Employee Benefits

Phone: (847) 592-0941
Fax: (847) 605-1494

Individual & Medicare

Phone: (847) 598-6006
Fax: (847) 605-1331

Linked Benefits LTCi, DI & CI

Phone: (847) 598-6005
Fax: (847) 619-9592

Employee Benefits

• Group Health Forms & Marketing
• Group Ancillaries

Individual

• Individual Health Forms & Marketing
• Individual Health Ancillaries

Medicare

• Medicare Supplement
• MAPD
• PDP
• MedicareCenter Software
• CSG Medicare Supplement Quoting

Linked Benefits LTCi

• Linked Benefits
• Linked Benefits/LTCi Quotes
• Traditional LTCi