OTHER IMPORTANT DOCUMENTATION
LICENSING REQUIREMENTS
In order to be approved as a producer for SLG
Benefits and Insurance, LLC and to be appointed by the insurance
company, the following required information must be received and
approved by both SLG and the carrier. These documents are required for any
producer or administrator that markets, services, collects commissions
and/or requests claim reimbursement’s on business in which SLG
Benefits & Insurance is the Stop Loss Program Manager. These documents
are generally one time only requirements. If the Approved and
Appointed entity changes their name or the appointed individual leaves
the entity, new documents will be required.
APPOINTMENT INFORMATION SHEET
Please complete the carrier Information Sheet for the agent or agency for which you
are requesting appointment. If you need appointments in multiple
states, please list each of the states on the appropriate line of this
form. It is not necessary to complete multiple forms.
Whether you complete electronically or in paper format, please be sure
that all information is complete and legible and that you have
provided copies of licenses in all states for which you are requesting
appointments. Please note that we will accept either copies or scanned
images of the individual state licenses. For faster appointment
processing we will accept electronic signatures on the Appointment
Form in addition to scanned images of licenses.
Please be sure to specify a contact person who regularly submits
requests for appointments and copies of licenses. This is the person
that SLG will contact with questions, requests for any additional
documents and information and notifications of all state responses.
Please note that commissions will be payable to the entity that the
Appointment is requested for; an Individual Insurance Producer or a
Business Entity Producer. In addition, all Policy service notices and
new or renewal proposals will be directed to the entity approved for
appointment.
If the Appointment is being completed as a Business Entity (Agency),
please include a separate listing of all licensed employees that may
produce and renew business with SLG. This listing should include the
licensed employee name, license type, license number, effective date
and expiration date. This information will be valuable in our
compliance record maintenance for the primary producers that work with
SLG.
PRODUCER AND COMPENSATION
AGREEMENT
This document addresses the nature of the
relationship between the Program Manager, SLG Benefits & Insurance,
LLC and the Producer. The Producer may be an individual or business
entity receiving commission or being compensated on a fee basis
directly from the employer group. The Producer initiates the proposal
process with SLG and maintains Policyholder service responsibilities.
A fully completed, endorsed and approved Producer and Compensation
Agreement is required for Producer Approval by SLG Benefits and
Insurance, LLC.
IRS FORM W-9
The Request for Taxpayer Identification Number and
Certification is required for Approval and Appointment.
Business Entity Producers will reference a Federal Tax Identification
Number and Individual Producer will reference a Social Security
Number.
It is the responsibility of the TPA or Producer to notify SLG Benefits
when an appointed Producer leaves their employment so we may terminate
the agent’s appointment with the insurance carrier. In addition,
Approval and Appointment documents will need to be submitted for any
individuals replacing terminated agents or new employees involved in
the placement of Excess Loss Insurance with SLG Benefits are hired. If
notification is not received, SLG reserves the ability to bill the TPA
or Producer for any state mandated fees incurred for the terminated
Producer.
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