I want to...

Complete new business documents for:

     Agent Checklist for Prescreens and Sold Groups

Change my group’s coverage

Drop or add a member to my group’s coverage:

  • SafeGuard Enrollment Form - Michigan
  • SafeGuard Enrollment Form - IL, IN, OH
  • SafeGuard Enrollment Form - Wisconsin
  • Waiver Form - Michigan
  • Waiver Form - IL, IN, OH
  • Waiver Form - Wisconsin
  • Complete a Billing Adjustment Worksheet

Make a death claim

  • Employer must complete a Death Claim Form

Make a disability claim

  • Employer, employee and attending physician must complete a Disability Claim Form

Designate an authorized user of the employer secure services portal

  • Group’s authorized representative must complete an Employer Portal Authorized Access Form

Authorize an individual to obtain my personal health information (PHI)

  • Member must complete a Designation of Person to Obtain PHI Form


Get appointed with USHL

Register for USHL online agent quoting