Fill out an Online Application

Fill out an online application form and provide a payment of $350/yr for each covered employee. The payment will be processed once your group has been approved.

Select your state below to fill out the application. If you have questions during the application process, please refer to our Application FAQs.

NOTES: 

1. On the application you will need to write in Classes of eligible employees (ex: Executives, Directors, etc...) and also the Plan Maximum Medical Benefit Elected. To determine the plan maximum eligibility, please use the chart below.
2. Attention Agents: If you are not appointed, please click here. Agents must be appointed prior to signing an application. For questions, please contact 260-469-2921.

Upload your Summary Plan Description (SPD)

A Summary Plan Description (SPD) upload button is provided within the online application if the participants have employer-sponsored health insurance.

Fill out an ACH form

Clients choose to pay their invoices via Automated Clearing House (ACH) transfer to expedite payments and participant reimbursement. You will automatically be redirected to this form after completing your application.

NOTE: The ACH Form button below is for employers who will be funding the claims. If you are an executive who would like to be reimbursed electronically then please click here to fill out the employee EFT form.

Provide us with a list of participants

Send us a list of the participants joining the plan along with their email addresses.

Potential participants fill out an Enrollment Card and EFT Form

Each potential participant will receive an email to fill out an online Enrollment Card and EFT Form (optional).
NOTE: This step cannot be completed until participants have been emailed.

Submit the Business Associate Agreement

Once BeniComp reviews and approves the application, an online Business Associate Agreement will be submitted to the employer contact to sign.
NOTE: This step cannot be completed until the application has been approved.

Fill out an Online Application

Fill out an online application form and provide a payment of $350 per employee per year. The payment will be processed once your group has been approved.

Select your state below to fill out the application. If you have questions during the application process, please refer to our Application FAQs.

NOTE: 
1. On the application you will need to write in Classes of eligible employees (ex: Executives, Directors, etc...) and also the Plan Maximum Medical Benefit Elected. To determine the plan maximum eligibility, please use the chart below.
2. Attention Agents: If you are not appointed, please click here. Agents must be appointed prior to signing an application. For questions, please contact 260-469-2921.

Upload your Summary Plan Description (SPD)

A Summary Plan Description (SPD) upload button is provided within the online application if the participants have employer-sponsored health insurance.

Provide us with a list of participants

Send us a list of the participants joining the plan along with their email addresses.

Potential participants fill out an Enrollment Card and EFT Form

Once an application is approved, the employer will receive the enrollment materials from a dedicated BeniComp Account Manager. 
NOTE: This step cannot be completed until the application has been approved.

Submit the Business Associate Agreement

Once BeniComp reviews and approves the application, an online Business Associate Agreement will be submitted to the employer contact to sign.
NOTE: This step cannot be completed until the application has been approved.