Get Wa Kaiser Permanente Small Group Employer Application 2019-2025

The WA Kaiser Permanente Small Group Employer Application is a crucial document for employers seeking to establish a small group health plan. This guide provides a clear, step-by-step approach to filling out the application online, ensuring that all required information is gathered correctly and efficiently.

Follow the steps to complete your application with ease.

1. Press the ‘Get Form’ button to access the WA Kaiser Permanente Small Group Employer Application and open it for editing.
2. Begin with Section 1: About Business. Enter the legal business name, any doing business as (DBA) names, and the physical street address. Ensure that all information matches what is on official business documents.
3. Fill in the contact details including phone and fax numbers, and select the type of business from the provided options (e.g., corporation, sole proprietorship, partnership, etc.). Include the date your business began operations and your Federal Tax ID number.
4. In Section 2: Other Medical Coverage, indicate whether your company or any affiliated companies have had group coverage through Kaiser Permanente in the past by selecting 'Yes' or 'No'. If applicable, provide the group ID and company name.
5. Continue in Section 3A: Employer Eligibility. Determine if your company is affiliated with another company that can file a combined tax return. If yes, provide the necessary information about the affiliated company.
6. In Section 3B: Employee Count, state the total number of employees (full-time and part-time) and elaborate on the number of eligible and enrolling employees in the subsequent fields.
7. Progress to Section 4: Domestic Partner Coverage and specify your intent to offer coverage by selecting 'Yes' or 'No'.
8. Complete Section 5: Continuation Coverage by answering whether your company had 20 or more employees for at least 50% of the preceding workdays.
9. In Section 9: Contract Signer Information, provide the details of the individual authorized to sign the contract. This will include their contact details and how you wish to communicate with them.
10. Lastly, read the agreement in Section 16 carefully before signing. Ensure all entries are accurate and attest that you meet the definitions and requirements set forth. Then, save, download, print, or share the completed application as necessary.

Begin filling out the WA Kaiser Permanente Small Group Employer Application online today to secure the health coverage you need.