Get Tennessee Small Group Form

Filling out the Tennessee Small Group Form online is a crucial step for businesses seeking group coverage for their employees. This guide will walk you through each section of the form, helping you provide the necessary information accurately and efficiently.

Follow the steps to complete your form with ease.

1. Click ‘Get Form’ button to obtain the form and open it in your designated digital form editor.
2. Begin by entering your company name as it appears legally. If applicable, include your doing business as (DBA) name.
3. Fill in the street address. Note that a P.O. Box is not acceptable. Include your city, state, and ZIP code.
4. If your billing address is different from your street address, fill in the billing address fields, including city, state, and ZIP code.
5. Provide your phone number and fax number, followed by the name, title, and date of birth of the primary company contact. This information is needed for electronic billing.
6. Enter the email address for the company contact, along with any additional billing or enrollment contact names and their email addresses if different from the primary contact.
7. Input your Federal Tax ID Number and the date your business was established, using the month and year format.
8. Select your employer classification from the listed options, including corporation, non-profit, partnership, and others.
9. Provide your Standard Industrial Classification (SIC) code and briefly describe the nature of your business.
10. Indicate the number of years you have been with your current insurance carrier, as well as the total number of carriers you have had in the last five years.
11. Answer whether multiple companies or addresses will be included under this plan. If ‘yes’, provide additional details.
12. Select your medical coverage options. Depending on the group size, various plan options will be available.
13. Indicate if your group qualifies for an exemption under federal mental health parity, and whether you have a flex plan under Section 125 of the IRS Code.
14. Provide details regarding funding or subsidizing any cost-sharing responsibilities under a high deductible health plan, if applicable.
15. Choose your dental coverage plan from the available Aetna Dental plans, noting that only one selection is permitted.
16. Review and complete sections related to life, short-term disability, and packaged life and disability coverage, noting eligibility requirements for different group sizes.
17. Answer questions regarding business eligibility, employee status, and coverage nuances like Medicare status and COBRA compliance.
18. As you finalize the form, ensure all sections are complete, and review your entries for accuracy.
19. Once satisfied with the information provided, users can save changes, download, print, or share the form as needed.

Start filling out the Tennessee Small Group Form online today to secure group coverage for your employees.