1. Obtain pre-approval for the case by contacting your Assurity Regional Sales Coordinator (RSC).
2. Complete and submit the Case Set-Up Form (16-405-05053) and for the group product only, the Worksite Group Employer Application. The agent of record and the person approving the agreement must sign these agreements, and include his or her title.
3. When enrolling with the paper application, here are a few guidelines:
a. All applications are state specific. Be sure to use the application for the state in which the application is signed.
b. The agent of record, who will be signing the applications, employer agreement and employees’ payroll deduction authorizations, and receiving commissions and/or an overwrite, must be licensed and appointed with Assurity Life Insurance Company in the state where the applications will be signed.
c. The proposed insured’s full legal name and signature must be the same.
d. Social Security number is required for all proposed insureds.
e. Issue age is the current age (last birthday) as of the policy/certificate issue date. If the proposed insured is over age 64, complete and submit the Medicare Disclosure Form (75-653-02253).
f. The first date of full-time employment with the employer must be completed on all applications. Applications missing plan codes, premium, beneficiary or other information will cause delays in processing and will require the application to be returned for completion.
g. Paper applications must be completed and signed in dark ink.
h. Paper applications that have “white-out” corrections will not be accepted.
i. If an incorrect answer is recorded on the paper application, cross it out and complete the application with the correct information. The applicant must initial the change.
j. Applications must be received at Assurity within 45 days of the application date. Applications older than 45 days will be declined and returned.
k. The application date must be the date the application was actually taken. Predated or postdated applications will not be accepted.
l. Applicant and agent signatures are required.