Meridio New Groups – Options Plus Plan

Submit New Group

Group*
Marsh Fleet
Company Name*
Tax-ID
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Effective Date*
MM slash DD slash YYYY
Billing Contact Name*
First Last
Billing Contact Email*
Plans Offered
- Choice MEC
- Choice MEC + Hospital Indemnity
- Preventive Dental + Vision
- Comprehensive Dental + Vision
Submitted by:
Meridio Association Groups
Association*
Company Information
Company Name*
Tax-ID
Phone
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Effective Date*
MM slash DD slash YYYY
Billing Contact Name*
First Last
Billing Contact Email*
Plans Offered
- Ultimate MEC
- Ultimate MEC + Hospital Indemnity
- Preventive Dental + Vision
- Comprehensive Dental + Vision
Submitted by:
Request New Association
Requested by:
Association Name*
Meridio Commission %*
Agent & Agency Name - 1
Agent & Agency Commission % - 1
Agent & Agency Name - 2
Agent & Agency Commission % - 2