I Terminated an Employee

Employee Termination Form

It is your responsibility to audit your bills from your carriers. If you find discrepancies, please contact us immediately so we can work with the insurance carrier to get this rectified as soon as possible.

You must contact us immediately after a termination or billing issue. Generally, the insurance carriers will only backdate changes up to 60 days.

Employer Contact Information

* Indicates required field

Company Name *

Employer Contact Name *

First

Last

Employer Contact Email *

Terminated Employee Information

Name *

First

Last

Reason for Termination *

Termination Date *

Work Email *

Personal Email *

Work Phone *

Home Address *

Line 1

Line 2

City

State

Zip Code

Country

Special Instructions *

Submit

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Our mailing address is:
Sailer Benefit Services, Inc.
948 inwood ave N oakdale, MN 55128
651-702-5626
Copyright © 2018 Sailer Benefit Services, Inc., All rights reserved.
If you have questions please feel free to contact us. 651-702-5626 or ClientServices@SailerBenefit.com