Get C15385-ff10-18sbm-10-18-mastergroupapplication-ff

Filling out the C15385-FF10-18SBM-10-18-MasterGroupApplication-FF online can be straightforward with the right guidance. This guide provides detailed instructions to help you complete each section accurately and efficiently.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the form and launch it in your online editor.
2. Begin with Section 1 – Company Information. Ensure you provide the full legal business name, DBA, billing address, and physical address accurately. This information is vital as all fields are mandatory.
3. For the primary group contact, enter the contact person’s name, phone number, title, and fax number. Only this individual will have access to manage group account information.
4. Complete the legal entity type by selecting the appropriate option from the choices provided, including options like ‘S-Corporation’ or ‘LLC’. Additionally, provide the Federal Tax Identification number.
5. In Section 2 – Eligibility, determine the total number of employees and enter the counts for full-time employees, eligible employees, and those enrolling in coverage.
6. Detail any employment-based affiliation and waiting periods as applicable, specifying if an orientation period is imposed and the specific waiting periods for employee coverage.
7. Transition to Section 3 – COBRA/Cal-COBRA Coverage Information. Answer questions about Cal-COBRA or Federal COBRA applicability and provide relevant enrollee counts.
8. In Section 4a, choose the health plans you wish to offer. Make selections carefully as combinations of plans can be restricted based on package options.
9. If applicable, fill out Section 4b to select dental, vision, and life insurance benefits, indicating employer contribution amounts for each.
10. In Section 5, ensure you understand the electronic distribution of Evidence of Coverage materials and provide your authorization and signature at the end of the form.
11. Finally, review all entries for accuracy, save your changes, and proceed to download, print, or share the completed form as needed.

Complete your application online now for an efficient group coverage setup.