Enrollment Process

Enrolling Your Company
 
Each employer group must complete a Sponsor Application Form. If you prefer, you can just print it and finish the process of completing them off-line.

Before filling in the Sponsor Application Form make sure you know:
(each highlighted term below will launch a window to provide more information)

• Which plan(s) you want
• The effective date for coverage to begin
• The premium based on monthly rates
• What waiting period you wish to use (0, 30, 60, 90 days)
• Which employees are eligible  
• The total number of eligible employees and the total number who wish to participate in the plan
• The name and address of your health insurance agent
  

Your sponsor number will be assigned upon receipt of your completed Sponsor Application.
 
 After completing the Sponsor Application Form and the Enrollment forms for the group, please forward these with the initial payment to Markel Insurance Company.  

Markel Insurance Company
Attn:  David Higgs
PO Box 3870
Glen Allen, VA  23058-3870

tel.  800-431-1270 ext.  7997         

Enrolling Your Employees                

For the initial enrollment, each eligible employee must complete an Employee Enrollment Form.

If an employee decides not to participate, please make sure the Refusal of Insurance section at the bottom of the first page is completed and signed. This is for your protection so that the employee cannot come back to you later and contend that you never offered him or her the coverage. Submit all completed forms, whether the employee is accepting or declining the insurance.

To enroll employees after the initial enrollment period, or make changes in an employee’s coverage, you can use the same employee enrollment form. It can be found on this website in the Administration section. Fill in Section A (Sponsor Information) on-line before printing the form and then give it to the employee to complete.
 
 
Employee Enrollment Form 
 
Employee Enrollment Form (Spanish) 

Enrollment Form for Prescription Card

Enrollment Form for Value Plan Card

Enrollment Form for Value Plan with PPO

Enrollment Form for Enhanced Plan

Enrollment Form for Enhanced Plan with PPO
 

Send completed forms to:

Pioneer Management Systems
P.O. Box 9040
West Springfield, MA  01090

tel. (866) 653-2542
fax (413) 265-2779