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Tim Wiedman Associates
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Client Services for Assurant Health
Forms for Assurant Health: For additional infomation from Assurant Health, visit their website at http://www.assuranthealth.com.

The following forms are for new groups setting up their plans. These should be returned to Tim Wiedman Associates:
Employee Application (Indiana)
Employee Application (Michigan)
Employee Application (Ohio)
Employer Application (Indiana)
Employer Application (Michigan)
Employer Application (Ohio)

To add a new employee, or change the status (ie add/remove child, etc) for established groups, use the appropriate employee app above. After completion, fax to Assurant Health at (317) 596-1565. To terminate an employee from the plan, call (800) 328-4316. When adding a new employee, be sure to complete the request within the time allowed for your waiting period. If you do not remember your waiting period, please contact us or call Assuran Health customer service at (800) 328-4316.

Note: These forms are in Adobe Portable Document Format (PDF). In order to view PDF files, you will need the Adobe Acrobat Reader. The reader is available for downloading free of charge at http://www.adobe.com/products/acrobat/readstep.html.