Get Wa Kaiser Permanente Small Group Employer Application 2021-2025

Filling out the WA Kaiser Permanente Small Group Employer Application online is a straightforward process that enables small businesses to apply for health coverage. This guide will help you navigate each section of the form with ease, ensuring that you provide all necessary information accurately.

Follow the steps to complete your application online.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Complete the 'About Business' section. Enter your legal business name, physical address, contact numbers, type of business, and federal tax ID. Ensure all entries are accurate to avoid delays.
3. In the 'Other Medical Coverage' section, indicate whether your company currently holds or has ever held group coverage with Kaiser Permanente. If yes, provide the necessary details.
4. In the 'Employer Eligibility' section, identify if your company is affiliated with others for tax purposes and indicate the total number of employees during the previous calendar year.
5. Provide details in the 'Eligible and Enrolling Employees' section. Enter total eligible and enrolling employees, and specify if you cover certain classes of employees or provide Medicare coverage.
6. In 'Domestic Partner Coverage', indicate whether you wish to offer coverage and fill out the relevant details as needed.
7. Complete the 'Employer Premium Contribution' section by selecting the percentage or fixed amount you will contribute towards employee premiums.
8. Fill in the 'Contract Signer Information'. Provide the name, title, and contact details of the responsible party for signing the contract.
9. Enter the 'Billing Contact Information'. This section captures details for the individual managing billing statements, ensuring accuracy in communication.
10. Specify the 'Benefit Offerings' and select any medical and dental plans you wish to apply for, following the plan-specific instructions.
11. Read through the important information provided within the application carefully to understand the agreement terms.
12. In the 'Agreement and Signature' section, ensure that the authorizing person signs and dates the application.
13. Once all sections are complete, save changes, download, print, or share the application as required.

Start your application now and ensure your business obtains the coverage it needs online.