Insurance Coordinator Handbook | Downloadable Fillable PDF

Transmittal Report

Transmittal reports make employer reporting easier.

Using and completing the Transmittal Report

Use Transmittal Reports to:

  1. Report deletions and changes when an Enrollment Form is not required.
  2. Reconcile an amount that is different from what was billed (additions, deletions, changes).

Note: This is a fillable PDF document, which allows you to enter information onto the form directly from your PC. Once you have completed the form, simply print and mail to the Trust.

Here are some examples you need to report:

  • Termination
  • Salary change
  • Retirement
  • Leave of absence
  • Medicare eligibility

Fill in your employer's name, group number, and the month the report is for. Then enter the employee’s name, subscriber number, and last date worked (if applicable). (For retirement, we use the last day worked as the official retirement date.)

Use the following codes on your Transmittal Report to indicate the type of change:

  • “A” for employee additions
  • “D” for deletions (terminations)
  • “C” for all other changes

Each type of change is discussed in detail on the following pages. When you list additions, deletions, or changes on a Transmittal Report, use a separate line for each plan and premium. Here are some other things to include when you send us the Transmittal Report:


Transmittal Report

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