Get Wi Dhs F-10181 2010-2026

This guide provides clear, step-by-step instructions for completing the Wisconsin BadgerCare Plus Employer Verification of Health Insurance form (WI DHS F-10181) online. By following these steps, you can ensure accurate and efficient submission of your information.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in your preferred online editor.
2. In Section 1, enter basic information about your company. Fill in the required Federal Employer Identification Number (FEIN) accurately, as it is essential for matching your information with your employees. Include the company name, telephone number, employer address, city, state, zip code, and the number of employees.
3. Proceed to Section 2, where you will provide contact information. Enter the name, job title, address, city, state, zip code, telephone number, fax number, and email address of the contact person for follow-up questions.
4. In Section 3, list any Doing Business As (DBA) names and their corresponding FEINs that apply to the health insurance information provided in subsequent sections. If you have multiple DBAs, you may attach a list.
5. Fill out Section 4 to provide information about health insurance access. Indicate whether you offer major medical health insurance to your employees. If yes, specify if you have an annual open enrollment period, and list the dates.
6. In Section 5, answer questions regarding your company's insurance premiums and structure. Indicate if premiums differ based on employee characteristics like age or health status.
7. Complete Section 6 by detailing the premium details for the various employee coverage groups. Enter the total monthly cost and the share that both the employee and the company contribute for each coverage type.
8. Use Section 7 to provide any additional comments or explanations regarding the health insurance coverages.
9. In Section 8, clarify the eligibility criteria for employees to sign up for the plans. Specify the type of employment, number of hours worked, job title, length of service required for enrollment, and when the coverage will commence.
10. After filling out the entire form, review all entries for accuracy. Save changes, download, print, or share the form as needed to ensure that it is submitted successfully.

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