Get Employeeelect For 2-50 Member Small Groups Employer ...

This guide provides a comprehensive overview of how to accurately fill out the EmployeeElect for 2-50 Member Small Groups Employer application online. It is designed to assist users in completing the form easily and effectively.

Follow the steps to successfully complete the application.

1. Press the ‘Get Form’ button to access the employer application form.
2. Begin with the first section by providing your company's details. This includes the name, group number, address, and other relevant information. Make sure to specify the type of employer (corporation, partnership, etc.) and provide the SIC code.
3. Indicate whether your company has been insured by Anthem Blue Cross within the past 12 months. If so, include the termination date of prior coverage, if applicable. Enter the Federal Tax ID number associated with your business.
4. Move to the Medical Coverage Preferences section. Select your employer medical contribution options and detail the percentage contributions per employee and dependent.
5. Choose from the medical plans you wish to offer. Make sure to review the options carefully and remember that Select HMO plans cannot be offered with other non-Select HMO plans.
6. In the Dental Coverage Preferences section, provide your contribution amounts and specify which dental plans you would like to offer.
7. Follow similar instructions for the Vision Coverage Preferences. State which plan you are choosing and how much you will contribute.
8. Complete the Life Coverage Selections by stating your employer life contributions and choosing the appropriate schedule based on your group’s needs.
9. Fill out the group’s eligibility details, including the total number of employees and the options for coverage for part-time employees.
10. Indicate your requested effective date for the coverage. Be mindful that actual effective dates may differ based on acceptance of the application.
11. Answer questions regarding the employee Leave of Absence at your company. Specify the duration of coverage during medical and personal leaves.
12. Review the Workers’ Compensation coverage information and provide necessary details of any medically enrolling employees.
13. Complete the Cal-COBRA, COBRA, and FMLA questionnaire, if applicable, ensuring that you provide accurate employee information.
14. Finalize the application by checking the appropriate affirmation box regarding the Employee Welfare Benefit Plan and signing the document.
15. Continue by completing any additional information required by your agent and follow instructions for submitting the application.
16. Once all sections are complete, save your changes, and you may choose to download, print, or share the form as necessary.

Complete your EmployeeElect application online today to ensure your small group benefits.