Provide the following information to ODS at least 15 working days prior
to the first of the month the coverage is to be effective.
- Premium: One month premium for coverage.
- Group Application: A completed group medical and/or dental application
that is signed by both the group and agent.
- Enrollment/Declination Forms: Submit either a completed enrollment or
waiver form for each eligible employee.
ODS will provide the following information to you:
- Group Application
- Enrollment Packets: (depending upon plan selected, some material may vary)
- Member Guides
- Benefit Summaries
- Enrollment Form
- Prescription Drug Claim Form (medical only)
- Mail Service Prescription Program (medical only)
- Declination of Coverage Forms