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Sold Group Requirements
Requirements to determine final rates
and approval
- Employer
Group Application completed
and signed by Employer and agent.
- Group
Employee Applications 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 Employer’s most recent
wage & tax
report
- Copy of PUP proposal quoted.
- Group
Employee Applications completed by all COBRA
Participants.
- If Employer would
like SecureOne to administer COBRA a COBRA Administration
Agreement must be completed and signed.
- Copy of Certificates of Creditable
coverage, as soon as available.
All Originals Must be
Sent to the Underwriting Department at Preferred United
Plans of Michigan. Do not cancel current coverage until
a written verification letter has been received confirming
the rates, plan design and effective date.
Preferred United Plans
of Michigan
678 Front Ave NW, Suite 420
Grand Rapids, MI 49504
(PO Box 1847 - zip 49501-1847)
Phone: (616) 454-9066
Marketing Toll Free: (888) 299-1196
Fax: (616) 454-4338
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Underwritten by Companion Life Insurance Company
• Administered by SecureOne Benefit Administrators, Inc.
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