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Choice Builder Admin Guide for Employers
To assist Employers with the administration of new hires, terminations, benefit and policy changes, etc., 30 Pages (Rev. 10/2011)
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Choice Builder Application Employee
This form may be used for new group employee enrollments, and new employee enrollments in existing Choice Builder groups. All Choice Builder Dental, Vision, Chiropractic, and Life enrollment options are included in this form., 4 Pages (Rev. 9/2011)
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Choice Builder Common Ownership Statement
To be completed by an Employer enrolling multiple groups as one. Groups must be commonly owned., 1 Page (Rev. 9-2009)
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Choice Builder EE Affidavit of Domestic Partnership
1 Page (Rev. 7-2009)
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Choice Builder EE Change Request Form
Complete this form ONLY if you are an active member who wants to update personal info, ADD/CANCEL dependent coverage or voluntarily cancel coverage, 3 Pages (Rev. 11-2009)
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Choice Builder EE Enrollment Guide
Provides information regarding Choice Builder plans, benefits, employee and dependent eligibility requirements, etc.
, 28 Pages (Rev. 10/2011)
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Choice Builder EE Enrollment Guide
Effective 7/1/2012
Provides information regarding Choice Builder plans, benefits, employee and dependent eligibility requirements, etc.
, 28 Pages (Rev. 4/2012)
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Choice Builder Employee Termination Notification
1 Page (Rev. 2010)
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Choice Builder Employer Change Request Form
1 Page (Rev. 2009)
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Choice Builder Language Assistance Preference Form
2 Pages (Rev. 9-2009)
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hard drive. If you do not have Adobe Acrobat Reader, click
here or on the "Get Acrobat Reader" Image, to download the
software.
For additional information, please contact Claremont at 800.696.4543
or
info@claremontcompanies.com
