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Harmony Brochures & Forms

Billing & Enrollment Customer Service

1-877-949-SBAM (1-877-949-7226)
HarmonyBill@sbam.org
sbamharmony.freshdesk.com

 

Submit a Freshdesk ticket

SBAM Membership & Sponsorship

Harmony Brochure

Agent Harmony Brochure

Harmony Contacts & FAQs

SBAM Membership Application

Rollover Letter for BCBSM/BCN Sponsorship

ACH Form for premium payments

ACH One-Time Form for premium payments

ECOS Form

Notify us of Salary amount changes 

 

COBRA Administration

SBAM COBRA Enrollment Form

SBAM COBRA Contract

NonBlue COBRA Enrollment Form

NonBlue COBRA Contract

COBRA ACH Form 

COBRA Brochure

Kushner Flexible Benefit Administration

POP, FSA HRA Enrollment Form & Agreement – Kushner

ACH Form for Kushner

Summary Plan Descriptions

Instructions to create an SPD

Sample Summary of Material Modification

Life and Disability

Group Specialty Benefits Brochure with Rates

Group Specialty Benefits Quoting Tool

Evidence of Insurability

Group Specialty Benefits Employer Enrollment Form*

Group Specialty Benefits Employee Enrollment Form*

Group Specialty Benefits Beneficiary Designation Form

Group Specialty Benefits Employee Termination Form

 

Group Specialty Benefits Sold Checklist
Group Specialty Benefits Agent Sell Sheet 

DearbornCares Employer Flyer
DearbornCares Employee Flyer

Group Specialty Benefits Group Benefit Summaries

Group Specialty Benefits Short Term Disability Claim Form
Group Specialty Benefits Long Term Disability Claim Form
Group Specialty Benefits Life Claim Form

Group Specialty Benefits Waiver of Premium Claim Form

*Please note when submitting salary information for sole proprietors on the life and disability enrollment form, “Earnings” means your net profit averaged for the lesser of:
a) the 2 most recent years just prior to your Date of Disability; or
b) the period that you have been a sole proprietor, if you have been a sole proprietor for less than 3 years. 
Annual, Monthly and Weekly net profit is figured on Form 1040 Schedule C as the gross income less total deductions. Deductions do not include depreciation or expenses for business use of home. Earnings do not include income received from sources other than Your Form 1040 Schedule C earnings.

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