Proposals
Request for rates form (51-99)
Census template (51-99)
Groups with 100 or more employees enrolled, please contact your Premera sales representative.
Pre-renewal
Group size certification
Group enrollments
Completed implementation materials must be received at Premera well in advance of the first of the month to ensure eligibility and receipt of ID cards by the groups start date.
Follow these steps to complete your enrollment:
Required documents:
Group master application
Circle, sign and date the Rate Exhibit to acknowledge your plan choice(s)
Enrollment spreadsheet (membership adds/drops or plan changes)
Other coverage questionnaire
- Return completed
enrollment documents for groups with 51-99 employees to AK51-99@premera.com. Groups with 100 or
more employees, please send to your Premera sales representative.
Note: Forms and documents will be provided for any groups requesting self-funded or defined funded options. Binder check will be required for stop loss.
Group renewals
Completed renewal documents must be received at Premera well in advance of the first of the month for renewing groups beginning coverage on the first of the following month to ensure eligibility and receipt of ID cards, by the groups start date.
Follow these steps to complete your renewal:
Circle, sign and date the Rate Exhibit to acknowledge your plan choice(s)
Required documents:
- Group verification report (provided by Premera)
- Enrollment spreadsheet (membership adds/drops or plan changes)
- Other coverage questionnaire
- Return completed
enrollment documents for groups with 51-99 employees to AK51-99@premera.com. Groups with 100 or
more employees, please send to your Premera Account Manager.
Note: Forms and documentation will be provided for any groups requesting self-funded or defined funded options.