Get 1 New Business Small Employer Application - Rogers Benefit Group

Filling out the 1 New Business Small Employer Application - Rogers Benefit Group online can seem daunting, but with the right steps, you can complete it easily and accurately. This guide provides a comprehensive overview of each section of the application to ensure you provide all necessary information.

Follow the steps to complete your application successfully.

1. Click the ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by entering the group information at the top of the application. This includes the full legal name of the group in the 'Group Name' field, any 'Doing Business As' designation if applicable, and the nature of the business along with the Standard Industrial Classification (SIC) code.
3. Select the employer classification that accurately describes your business structure — whether it’s a corporation, partnership, sole proprietorship, or other. Then fill in the group's physical address, including city, state, and zip code.
4. Provide the name and title of the decision-maker for the group. You will also need to fill out the mailing address, if it's different from the physical address, along with the contact person's name, title, phone number, and email address.
5. Next, indicate your workers' compensation carrier and your prior health insurance carrier. Additionally, enter your Tax Identification Number (TIN).
6. Specify the original effective date and the benefit period of the policy. Indicate whether it is a calendar year or non-calendar year.
7. In the eligibility information section, fill out the employer contribution percentages for employees and dependents, the waiting period days, and details on adding or terminating eligible employees.
8. Answer the questions regarding the average total number of employees in the previous year and the current number of employees, while specifying details about full-time, part-time, and seasonal employees.
9. Determine if your company is a member of a controlled group of corporations, and if yes, complete and attach the necessary common ownership form.
10. Fill out the health plan summary information for each plan selected, including plan names, Rx options, deductibles, and copayments.
11. Review the coverage acceptance or refusal section, indicating whether you accept or decline the offered coverage, and complete the necessary addendum if accepting.
12. Finally, review the applicant responsibilities and acknowledgments before signing. Enter the date, your printed name, and title along with the agent’s name and license identification number if applicable.
13. Once complete, ensure you save your changes, and download or print a copy for your records. You may also share the completed form as necessary.

Complete your documents online today to ensure swift processing.