Required Forms
The documents you need to submit for Express Underwriting quote requests are:
- Express Underwriting Request Form
211KB - Download PDF
- Census information from your quote
(Specify census for each location for multi-location employers.)
Plus
one of the following:
- Humana Employee Applications (Enrollment Form)
- Other Carrier Employee Applications
- Humana Risk Assessment Form
As appropriate by state and case size. (Employee applications not required.)
6KB - Download PDF
- Approved Agency Questionnaires — Comprehensive, employee-level health assessment. (Subject to Humana Underwriting approval.)
Submit the forms directly to Easy Rate at the fax or e-mail address in the Express Underwriting Request Form.
*Submissions requiring follow-up for additional information may take longer. Final rates subject to change if additional information is received.