NEW GROUP ENROLLMENT CHECKLIST
FOR 2-5 ENROLLING CONTRACTS
Checklist Attached
FULLY INSURED (51-99)
Non-Virgin
1. Completed PGQ form w/ Signature
2. Member Level Census
3. State Mandated Reporting (Claims vs Premium and Large Claim Listing)
4. Summary of Benefits
5. Current invoice
Virgin
1. Completed PGQ form w/ Signature
2. Member Level Census