What is required before approval and final rates can be determined by US Health and Life Insurance Company

• Group must be a current member, in good standing, of the Central, Southeastern or Western Chapter of the Associated Builders and Contractors of Michigan, Inc.
• Employer Group Application (148KB PDF) completed and signed by Employer.
• Employee Enrollment Forms (56KB PDF) completed and signed by each Employee, as well as Employees in their waiting period, if their effective date is within 60 days of the group's effective date. Also, please note that if Employee is married, the spouse must also sign the application, regardless of coverage selected.
• Check for first month's premium.
• Copy of current billing statement.
• Copy of renewal letter from current carrier.
• Copy of Employer's most recent wage & tax report.
• Copy of PUP-CHC proposal quoted.
• Employee Enrollment Forms (56KB PDF) completed by all COBRA Participants.

All Originals Must be Sent to the Underwriting Department at SecureOne.

Do not cancel current coverage until a written verification letter has been received confirming the rates, plan design and effective date.