Miscellaneous form instructions

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Appointment of Administrator and Hold Harmless Agreement

This form is used by Assurant Employee Benefits to grant a policyholder's request that a TPA or their brokers is the policy administrator of their accounts to their entire policy. (Typically in coordination or in preparation for an amendment.)

Appointment of Administrator and Hold Harmless Agreement - Online Advantage

This form is used by brokers to request access to administration privileges for Online Advantage.

Appointment of Correspondent

This form is used by employers to grant their brokers administrative access to their Online Advantage for Employers accounts.

Field Underwriting Assurance

This employer form is used on new cases to increase the life or LTD amount and medical evidence does not need to be provided to Assurant Employee Benefits. The form can also be used when a new account is added or when there is an increase to report.

Group Insurance Preliminary Application

This employer form is required for all new coverage(s) even those being added to an existing policy. The form should be completed and signed by the employer in its entirety prior to the policy effective date of coverage for which the employer is applying. The application, binder check and any other materials required for submission must be mailed to the appropriate Assurant Employee Benefits Sales Office.

Note: This form is for adding coverage(s) to a group contract NOT for an individual application.

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