McLaren Health Plan
New Group Submission

New Group Submission

At McLaren Health Plan, we strive to give all of our agents and groups exceptional service throughout the selling and group installation process. We know it is important to you that the groups that choose McLaren Health Plan are ready on their effective date.

To ensure our groups receive the exceptional service they deserve, please use the checklist below to ensure all Sold Group Information has been sent to McLaren Health Plan:

Sold Group Checklist - Large Group

Thank you for choosing McLaren Health Plan Community! Please supply all the following items to ensure appropriate processing of your group. Completed paperwork should be submitted 30 days prior to requested effective date.

• Group Enrollment and Coverage Agreement - A completed, signed and dated Group Enrollment and Coverage Agreement and all exhibits
• Plan selection - Please indicate the plan selected by submitting a copy of the BIB (Benefits in Brief).
• Enrollment Forms - Enrollment/Change forms must have birthdates, SSN’s, PCP selection for subscriber and all dependents enrolling in the plan. Must be signed by employee and group administrator. Please discuss other forms or electronic files with the sales executive prior to submitting enrollment forms.
• Employee Waiver Forms - All employees waiving coverage must complete and sign an Employee Waiver Form. A list of waivers signed by group or an email from the group is acceptable.
• Quarterly Wage Detail Report - Please provide the most recent Quarterly Wage Detail Report. If this is not available, please provide the last invoice for the prior carrier.
• Group Status Verification Form - A completed, signed and dated Group Status Verification Form.
• Proof of worker compensation coverage.
• Completed paperwork can be emailed (secure only) to your sales executive.

Download the Sold Group Checklist - Large Group

Sold Group Checklist - Small Group

Thank you for choosing McLaren Health Plan Community! Please supply all the following items to ensure appropriate processing of your group. Completed paperwork should be submitted 30 days prior to requested effective date.

• Small Group Master Contract - A completed, signed and dated Small Group Master Contract and all exhibits.
• Plan Selection - Please indicate the plan selected by circling the quote sheet.
• Enrollment Forms - Enrollment/Change forms must must have birthdates, SSN’s, PCP selection for subscriber and all dependents enrolling in the plan. Must be signed by employee and group administrator.
• Employee Waiver Forms - All employees waiving coverage must complete and sign an Employee Waiver Form.
• Binder Checks  - Paperwork must be accompanied with a binder check for the first month’s premium payable to: McLaren Health Plan Community.
• Group Underwriting Roster Payroll Register - Completed Group Underwriting Roster with group administrator’s name and signature on page 1.
• Quarterly Wage Detail Report – Please provide the most recent Quarterly Wage Detail Report. If this is not available, please provide the last invoice for the prior carrier.
• Group Status Verification Form - A completed, signed and dated Group Status Verification Form.
• Delta Dental Information
  • Plan selection - see available Delta Dental Plans and Rates
  • Completed Delta Dental Eligibility Enrollment/Update form for each subscriber and dependents
  • Completed Delta Dental Client Information form
• Pediatric Dental Attestation Form - Small Group Pediatric Essential Health Benefit Acknowledgement form must be completed and signed.
• Proof of worker compensation coverage
• Completed paperwork can be emailed (secure only) to your sales executive and binder checks should be sent to:
  • ATTN: Finance
    McLaren Health Plan
    G-3245 Beecher Road
    Flint, MI 48532

Download the Sold Group Checklist - Small Group