May Insurance Services, Inc.

STARMARK (Trustmark)
http://www.starmarkinc.com/cps/rde/xchg/starmark/hs.xsl/index.htm

GROUP SUBMISSION REQUIREMENTS
    1. Employer Application UW2 3/08
     2. Employee Application UW3 1/09 - enrollment/waivers OR Ohio Universal App1210
    3. EFT Sign-Up AD43 (optional)
    4. Most recent prior carrier invoice
    5. Starmark proposal/prescreen information - please circle the plan selected
    6. Quarterly wage/tax or OBES - please reconcile: indicate PT, FT or terminated (incl. date) and add new hires
    7. Company's business check for 1st month's premium made payable to Starmark


Applications
      Application EE - Healthy Edge 9/11
      Application ER - Healthy Edge 9/11
      Application (see above)
      Change form (request to change AD6-1)   Change name, address or beneficiary.
      Claim Form
         Dental CL3
     Contingent Offer Transmittal Form T401-01 3/11
      Continuation of Coverage Election Forms (state continuation)
         Employee form
         Spouse/Children
     EFT Sign-Up AD43
     Employer Application UW2 3/08
      Employee Application UW3 1/09 or Ohio Universal App1210
      Certificate of Non-Discrimination
      Express Connect
            Employee S655-43 2/11
            Employer S655-39 4/11
      HIPAA Privacy & Security Amendment
      List of authorized representatives
      Network & Medical Management Precertification AD37 3/11
      New Business Submission UW7 1/11
      Plan Sponsor Certificate
      Sample ID cards
      Special Enrollment AD41 9/10 Please use if previously waived and qualifying event applies.
      Termination/Waiver Form 5645-11 (2008)

Brochures/Marketing Packet
    Aetna Network Flyer S669-241 11/08
     Consumer Health Series (HSA) MK75 10/10 (brochure)
           Colonoscopy Insert MK98 12/08
           Consumer Health Select MK112 4/11
           State Page MK10        10/10
      Discover the HSA Advantage - Brochure & Savings Insert
      Health Care Reform Mandated Benefit Provisions T500-74R 6/10
     Health Plan Comparison Brochure MK 77 12/10
     HealthyEdge PPO Brochure 
     HealthyEdge CDHP Brochure
     Signature Series (Traditional) MK74 (add State Insert MK10, MK75, and MK98 below) 10/10
           Colonoscopy Insert MK98 12/08
           Signature Series Select MK110 4/11
           State Page MK10 10/10
  
         
Guides
     Dual Option Guide 4/10
     Employer Guide AD44
     Online Administration
          Express Connect (employee) S655-43 Enrolling online
          Express Connect (employer) S645-39
          ACE (Automated Customer Environment) S645-4
               - order ID cards/certificates, access billing statements/history/EFT, update employee address, add coverage for
               newborn, process current member terminations/dependent waivers, and view enrollment records.
     Health Care Reform Mandatory Benefits 10/10
     Producer Guide MK-2 10/10
     Understanding your EOB  CL85  9/10
     Understanding your ID 5669-301 8/10
     Understanding your Premium  AD38
     Underwriting Guidelines 3/09
     State-Specific Page - list of forms, networks, and other UW information
     Healthy Foundation Flyer EE T500-42 12/10
     Welcome to Healthy Foundation Flyer ER T500-82 3/11

Licensing
      Appointment Questionnaire - complete and submit with:
              Copy of license
              Copy of E&O deck page
              W-9
              Voided check should you request direct deposit