Get Employer Application For Large Group

Filling out the Employer Application For Large Group online is a crucial step for organizations with 100 or more eligible employees seeking health coverage. This guide will walk you through each step of the application process, ensuring that you complete the form accurately and efficiently.

Follow the steps to successfully complete your application.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
2. Fill in the general information section, providing the group's legal name, street address, contact person's details, and tax ID. Ensure all fields, including the billing address if different, are completed accurately.
3. Indicate whether your group is a multi-location company and provide details about your internet access. Include the number of years in business and the total number of locations.
4. Select the organization type that applies, such as partnership or corporation, and describe the nature of your business.
5. Complete the waiting period section, indicating any waivers and specifying eligibility criteria for new hires.
6. Input the number of employees currently on COBRA and provide details on employees who have terminated in the last 12 months.
7. Specify if you have Workers’ Compensation and include the name of your carrier, if applicable.
8. Provide information regarding your health benefits plan, including ERISA plan status, industry code, and participation levels.
9. Indicate the number of employees applying for each type of coverage, including medical, dental, vision, and any life or disability coverage.
10. Complete the contribution section, detailing the employer's percentage contribution for each type of coverage.
11. Address any required disclosures regarding prior claims and current health status of eligible employees.
12. Ensure that you read and acknowledge the important certification and fraud statement at the end of the application.
13. Sign the application and include the broker information if applicable.
14. Finally, review the completed form for accuracy, save your changes, download, print, or share the form as needed.

Complete your Employer Application For Large Group online today to ensure timely processing of your coverage.