Please Provide the Following
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Please use this checklist to ensure that all forms and information needed to process your group applications are included in the submission packet.
Please Provide The Following □ GA New Group Submission Application.
□ Application for Group Insurance/Master Application.
□ Enrollment forms and/or census (formatted).
□ DHMO Application (if applicable). Please note: if DHMO sells with a PPO or another line of coverage,
MetLife will require both the DHMO Application and the Master Application.
□ Sold proposal (with broker’s signature on the rate summary page).
□ Binder check for the first month’s premium.
□ GA disclosures for the broker and customer to review. Signature not required.
No need to return to MetLife.
For Broker □ Non-Standard Commission Agreement (if flat comp sells, please include this form).
Mail all documents to: Claremont Insurance Services, 2999 Oak Road, Suite 810, Walnut Creek, CA 94597. For assistance with open enrollment meetings and onsite application reviews, call us at 800.696.4543.