The Michigan Self-Insured Group Notice of Acceptance of Membership (fill-in form) is used by employers who are self-insured and provide coverage for their employees in the state of Michigan. This form is used to notify the Michigan Self-Insured Group (MSI) of an employer's intent to become a member of the group. The form contains information on the employer, the type of coverage, the number of employees, and the start and end dates of the coverage. The form also requires a signature from the employer and the MSI's acceptance of the employer's application. There are two types of Michigan Self-Insured Group Notice of Acceptance of Membership (fill-in form): one for initial applications and one for renewals of membership.
The Michigan Self-Insured Group Notice of Acceptance of Membership (fill-in form) is used by employers who are self-insured and provide coverage for their employees in the state of Michigan. This form is used to notify the Michigan Self-Insured Group (MSI) of an employer's intent to become a member of the group. The form contains information on the employer, the type of coverage, the number of employees, and the start and end dates of the coverage. The form also requires a signature from the employer and the MSI's acceptance of the employer's application. There are two types of Michigan Self-Insured Group Notice of Acceptance of Membership (fill-in form): one for initial applications and one for renewals of membership.
