The following forms are to be completed as applicable to request rates from Lovelace’s Underwriting Department as well as finalize the sale with the LHP Commercial Sales Department.

Requesting a Quote

 Request for Proposal Form - 1006

 Census (in Excel for data entry)

 Census (PDF - print and complete)

 LMAF (Lovelace Medical Assessment Form) - English

 LMAF (Lovelace Medical Assessment Form) - Spanish

 UMAF (Universal/Uniform Medical Assessment Form) - English

Closing the Sale

 New Group Implementation Checklist

 Group Information Form

 Proof of Dependency

 Waiver of Insurance Coverage Form

Note: You may use your own forms as long as they contain all information requested in the Lovelace forms.

For your reference the Lovelace Underwriting Guidelines are provided also.

 Underwriting Guidelines

SCI (State Coverage Insurance) Program Information:

• The Request for Proposal form includes an area to denote if the employer group plans to offer the SCI program; please indicate on the form if applicable.
• The census for submitted should indicate person(s) who will enrolling in SCI.
• If you have additional questions, please visit the SCI area of our website or contact your Lovelace Sales Representative.