Coffey & Company appreciates the opportunity to provide the service and support your business deserves. Plan administrators have a variety of methods at their disposal to request enrollment changes.
The enrollment, change, and termination forms below can be used for any benefit currently being billed through Benefit Mall. Once completed, they can be mailed, faxed, or e-mailed to your account representative for processing. All completed forms received by 5:00 PM are turned around by 12:00 PM the following business day. We maintain electronic documentation of all forms and submissions to our carriers so as to ensure that any disputes are resolved quickly and accurately.
PLEASE NOTE: The above forms are generic. If you would like cutomized forms unique to your business and benefit program, please contact your account representative
Through our partnership with Benefit Mall, clients have access to a personalized benefit site at
Not only does the site provide easy access to the current enrollment and benefit information, but it allows for online enrollment, termination and change request. If you are a current client and would like to know more about how to take advantage of this free service, please contact Brad Leddon.