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New Group Set up Questionaire

 

    Fill Company Details Below

  • Company Address:

  • Company Primary Authorized Signer

  • Address (if not same as company address):

  • Company Human Resource Person

  • Address (if not same as company address):

  • Company Billing Contact

  • Address (if not same as company address):

  • Workers' Comp

  • We can show per paycheck deductions for your employee if you like.

  • New Hire Waiting Period - Coverage starts First of the month following

  • Are we going to deduct Employee Premium Contribution on Pre-tax basis?

  • What is/are the employer premium contribution for all the plans (Fixed dollar or Percentage)?

  • Optional

    Do you want to import company internal Employee ID into EaseCentral? If yes, please add it to the employee census spreadsheet. Fill up the attached employee census spreadsheet – just employee info no dependents info.

 

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