1. Each ELIGIBLE EMPLOYEE needs to complete the following:
2. The EMPLOYER needs to complete the following:
WMI Forms & Updates
|Are you a business interested in obtaining a quote for Group Health Insurance?
|Please submit all forms upon completion to our office at
Glacier Insurance Strategies
2602 Hwy 2 East Kalispell, MT 59901
Ph: 406-257-7680 Fax: 406-257-7685
|Currently Insured with WMI Mutual Insurance Co. and need Additional Forms?
Please make sure details are provided in the appropriate section
if "yes" is answered to any of the health questions.
A Newly Eligible Employee wanting to come onto the existing plan must complete the following:
Use this form if an employee wants to change his/her name, remove or add
dependents to existing coverage or make changes to a beneficiary. In order
to add dependents to an employee's health coverage after enrollment there
must be a qualifying event. Marriage, birth, adoption, or loss of coverage
elsewhere are all examples of qualifying events. Any changes must be
submitted to GIS within 30 days of said event.
Use this form if WMI has requested accident information regarding a claim.
Use this form to let WMI know if you or any of your dependents are
currently covered under any other health insurance policy in addition to
your coverage with WMI Mutual Insurance Co.
Employers are also required to submit a Payroll Report for all employees. Remember that
employers are required to pay a minimum of 75% of the single employee rate.