Current Group Census

Acme Manufacturing
Plan Year: January 1, 2005 - December 31, 2005

Today's Date: December 29, 2005
General Instructions:
  1. It is the Employer’s responsibility to update their group’s census information on a monthly basis.  Coverage eligibility and billing records will be updated automatically upon receipt of monthly updates.
  2. Census updates are due by the 15th of each month.  Invoices will automatically be generated on that date, with a due date no later than the 1st of the month in which coverage will be effective. 
  3. Eligibility changes occurring after the 15th of the month will become effective immediately.  Billing for these changes, from the appropriate effective date, will occur in the following month. 

Updating your Census:
There are four scenarios relating to your group census updates.  Instructions on how to handle them using Simplicity’s convenient electronic update are found below:
Monthly Update, no changes: If there have been no changes since your last update, click the icon below to generate an automatic e-mail update to Simplicity.
Add a new Employee: Click the icon below to add a new Employee and fill in the required information.  Coverage will become effective under the terms of your Plan Description.  Benefit cards, Benefit Summaries, a Plan Description and a new Member Orientation Package will be mailed within 3 business days.
Add a Member: Click the icon to the left of an existing employee’s name to add a new dependent to their coverage.  This will generate an automatic e-mail to Simplicity.  Fill in the required information.  Coverage will become effective under the terms of your Plan Description.
Delete a Member: Click the icon to the left of the employee or their current dependent’s name.  This will generate an automatic e-mail to Simplicity.  Fill in the required information.  Coverage will be terminated under the terms of your Plan Description.  Deleting the employee will also terminate coverage for all dependents. 

Acme Manufacturing Group Census, as of 12-29-2005

Monthly Update:
Add a
Member		 Delete a
Member		 Request an
ID Card		 Member
code		 Employee Name Employee D.O.B. Employee SSN Dependent Name Dependent D.O.B. Address City State Zip Phone Drivers License
۩ ۩ ۩ 1 James, Frank 12-20-1960 466-98-0961     123 Main St. Chester PA 18921 215-921-0356 PA-98756514374
  ۩ ۩ 1-2       James, Dorothy 1-11-1966 123 Main St. Chester PA 18921 215-921-0356  
  ۩ ۩ 1-3       James, Harold 4-20-1990 123 Main Street Chester PA 18921 215-921-0356  
۩ ۩ ۩ 2 Earl, Robert 3-28-1956 567-02-5412     345 First Ave. Chester PA 18922 215-921-0009 PA-67894265342

Monthly Update - No Changes

The last change to our group’s census was made on ______________ and was to _____________________________.

For the purposes of this monthly update dated _______________, there have been no changes since.

Add a new Employee - e-mail form

Effective Date
Employee Name
Employee D.O.B.
Employee SSN
Dependent Name
Dependent D.O.B.
Address
City
State
Zip
Phone
Drivers License