[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-281058-105":3,"detail-sidebar-cat-1-en-105":81,"doc-detail-281058-en":126},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","client-change-letter-of-explanation-underwriting-review-checklist","Client Change Letter of Explanation - Underwriting Review Checklist","","Client Change Letter of Explanation provides a structured template for submitting eligibility-related changes to an insurer. It outlines when updates are limited to client renewal and when off-cycle requests must be forwarded to Underwriting by the Sales team. The form details required demographic information, requested effective date, eligibility and dependent coverage selections, and a change-details narrative supporting the requested update. It also includes a signature block for an authorized representative and return instructions on company letterhead, referencing the need for potential additional documentation to validate compliance.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/letters/","Letters",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/client-change-letter-of-explanation-underwriting-review-checklist/281058/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/client-change-letter-of-explanation-underwriting-review-checklist/281058.png","ImageObject",442,249,{"name":42,"@type":43},"Logic","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-20","2026-09-16",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",12,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"When can client eligibility requirements be updated using this letter?","Question",{"text":63,"@type":64},"Eligibility requirements may only be updated at renewal. Off-cycle requests are forwarded to Underwriting by the Sales team.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"What demographic change details are required in the letter?",{"text":68,"@type":64},"The letter requires the requested effective date of the change and a detailed reason under “Change Details” for any and all changes. It also asks whether address changes apply to all contact types and whether “Other” applies when changes are not tied to ownership, EIN, or business structure.",{"name":70,"@type":61,"acceptedAnswer":71},"Who must sign the Client Change Letter of Explanation?",{"text":72,"@type":64},"An authorized representative must complete the signature section, including printed name, signed name, date, email, and phone number.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},281058,1790736006,{"code":4,"msg":82,"data":83},"success",[84,89,93,98,103,108,113,117,122],{"id":85,"doc_module":22,"doc_module_name":25,"category_name":86,"show_sort_weight":87,"slug":88},11,"Presentations",90,"presentations",{"id":55,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":110,"show_sort_weight":111,"slug":112},17,"Forms",40,"forms",{"id":114,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":115,"slug":116},18,30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":82,"data":127},{"doc_id":79,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":114,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":26,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":22},1099513958762,"https://ap-avatar.wpscdn.com/avatar/1000023916a998db790?x-image-process=image/resize,m_fixed,w_180,h_180&k=1784791008015729253","Client Change Letter Of Explanation (template) Checklist  \nNote** certain changes may require Underwriting review, additional documentation to validate compliancy with the Underwriting Guidelines and may only be made at a client’s renewal. Please refer to our Underwriting Guidelines for policy and procedures or reach out to your Sales department.  \n􀀀 Submit on Company Letterhead  \nEligibility Requirements (may only be updated at renewal. Off-cycle requests will be forwarded to Underwriting by the Sales team)  \n􀀀 Updated at renewal  \n􀀀 Change details listed  \nDemographic Changes  \n􀀀 List the requested eff date of the change  \n􀀀 Check‘Other’ if the group name or physical address is not due to an ownership, EIN or business structure change  \n􀀀 Check if the address change is applying to all contact types  \n􀀀 Provide a detailed reason under the‘Change Details’ for any and all changes  \nSignature Section (by an authorized representative)  \n􀀀 Print name  \n􀀀 Sign name  \n􀀀 Date  \n􀀀 Email  \n􀀀 Phone number  \nDate:   Client \\#:    \nClient Name:    \nDear Highmark,  \nPlease update the below eligibility requirement(s)*  \n􀂅 Probationary Period (may not exceed 90 calendar days)  \nChange Details:  \n􀂅  \nEligibility Hours  \nDependent (check any/all that apply)  \n􀂅 No longer offer eligible dependent coverage Make coverage available to  \n􀂅 Domestic Partner  \n*Eligibility requirements may only be updated at renewal. Off-cycle requests will be forwarded to Underwriting by the Sales team.  \nFor the below changes we understand that Underwriting may request additional documentation to validate compliancy with the Underwriting Guidelines regarding the specific change.  \nEff date:    \n􀂅 Group Name 􀂅 Physical Address 􀂅 Physical Address and all contact types Our Group Name and/or Physical Address change is due to one of the below.  \n􀂅 EIN 􀂅 Ownership 􀂅 Business Structure 􀂅 Other  \nChange Details (e.g., name, address, ownership/business structure, date sale/acquisition was finalized, enrollment increases/decreases, etc.):  \n\n| Sincerely, |\n| --- |\n| Authorized Representative Name (Please Print) Title\u003Cbr>By typing your name on the signature line below, you understand that you are creating an electronic signature which has the same effect as a written signature, and you are representing that you have reviewed and submitted this form accordingly. |\n| Signature (please hand sign if this is a paper request) Date |\n\nEmail Phone  \nPlease return this document on your company letterhead to your Sales team.  \nAny other updates not listed above may be submitted to your Sales team via email, fax or phone.  \nLTR-064-WV- (Rev 03-10-2020)","cbCaihVvS4pB7ZSi","https://ap.wps.com/l/cbCaihVvS4pB7ZSi","pdf",143974,"English","# Checklist and submission rules\n## Eligibility update timing and Underwriting review\n## Submission on company letterhead\n\n# Required change information\n## Demographic changes and effective date\n## Group name and physical address scope\n## Change details and reason\n\n# Letter fields\n## Probationary period and eligibility hours\n## Dependent coverage selections\n## Signature and contact information","[{\"question\":\"When can client eligibility requirements be updated using this letter?\",\"answer\":\"Eligibility requirements may only be updated at renewal. Off-cycle requests are forwarded to Underwriting by the Sales team.\"},{\"question\":\"What demographic change details are required in the letter?\",\"answer\":\"The letter requires the requested effective date of the change and a detailed reason under “Change Details” for any and all changes. It also asks whether address changes apply to all contact types and whether “Other” applies when changes are not tied to ownership, EIN, or business structure.\"},{\"question\":\"Who must sign the Client Change Letter of Explanation?\",\"answer\":\"An authorized representative must complete the signature section, including printed name, signed name, date, email, and phone number.\"}]","Client Change Letter of Explanation - Underwriting Review Checklist | PDF",1789563859]