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Welcome To Milton Park Partners

As the business owner, you will need to fill out both the Application and the Medical Questionnaire.

 

The Application is focused on gathering information about your business, listing all your employees, and answering questions about your current benefits. Once you have completed all the required fields, you can click the Submit button to apply your eSignature to the application and submit for review. If any of the required fields have not been filled out, you will see a listing of those fields on the Submit page.

 

The Medical Questionnaire is focused on gathering information on you and your dependents, desired coverage, and answer a few basic health questions. Your answers are not visible to your employer. Once you have completed all the required fields, you can click the Submit button to apply your eSignature to the application for review. If any of the required fields have not been filled out, you will see a listing of those fields on the Submit page.

 

You have now completed your application and it will be submitted to underwriting for review and you will receive an email verifying it was received. Please look for an email confirming receipt of your application. 


Thank you for applying!

The Staff & Management
Milton Park Partners

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How did your find out about us?

Primary Business Account Owner






Company Information












Additional Employees
Please provide use with the employees first name, last name and email address so we can send them the health questionnaire for them to submit to underwriting.









If you have more than three additional employees please call us at (678) 480-5200 or you can  
email use at sales.app@miltionparkpartners.com for additional information on adding more people to your plan.
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Current Providers





Please Provide Us With You Current Work Comp Information



Work Comp Underwriting Letter
If your plan includes Work Comp we will need your to download this sample letter and complete the information requested to ensure that you have the correct coverage for your company. Once completed, email the letter to sales.app@miltonparkpartners.com as soon as possible prior to us activating your plan.
WC Letter Download
Current Healthcare & Benefits Information








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Type Of Coverage
BCBS Health Plan Rates
Primary Employee










Additional Benefits Questions


Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.






Adding Additional Family Members To Your  Plan

Spouse










Additional Benefits Questions


Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Dependent Child #1










Additional Benefits Questions


Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Dependent Child #2










Additional Benefits Questions


Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Dependent Child #3










Additional Benefits Questions


Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.







Additional Information Required

Please provide full details here.  We will need you to provide us with the following information in detail. The more detail you provide us speeds up the processing of your application.






If you have more than three children you would like to add to your plan please call us at (678) 480-5200 or you can  email use at sales.app@miltionparkpartners.com for additional information on adding them to your plan.
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Disclaimer & Signature 
Please note that once you press the submit button you will be presented with an overview of the the information you supplied for review.  At the bottom of the review you will be required to read the disclaimer associated with the application and terms of service. 

You will then be presented with a box for you to sign and provide the authorization information necessary to move forward.  This is used to verify of who you are.  This form will then be emailed to you for final approval to complete the submission process.
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Atlanta, GA 30022   •   (678) 480-5200  •   www.MiltonParkPartners.com
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