Get Premium Only Plan Document Form

Filling out the Premium Only Plan Document Form online is a straightforward process designed to help employers establish a Premium Only Plan. This guide will walk you through each section of the form, providing clear instructions to ensure a smooth completion.

Follow the steps to successfully complete the Premium Only Plan Document Form.

1. Click ‘Get Form’ button to access the Premium Only Plan Document Form and open it in your preferred editor.
2. Begin with Section 1 – Company Information. Fill in your company's legal name, address, city, state, zip, main phone and fax numbers, website, entity type, federal tax ID, and fiscal year end date. Make sure all information is accurate, as it is necessary for document creation.
3. In Section 2 – Contact Information, provide the name, title, company, phone number, fax number, and email of the primary contact. Similarly, fill in the lead broker contact information, if applicable.
4. Proceed to Section 3 – Plan Information. Choose between the Basic or Comprehensive POP Plan and input relevant details such as the plan year start date, types of insurance offered, eligibility criteria, and frequency of entry dates for employees.
5. Lastly, complete the Application Agreement / Signature section by affirming the accuracy of the application. Add the date and obtain the signature of an authorized representative, including their title.
6. After filling out the form, you can save your changes. You may then download, print, or share the completed form as needed.

Start completing your Premium Only Plan Document Form online today!