Get Group Master Application - Employers - Group Health Cooperative

This guide provides a clear and supportive approach to completing the Group Master Application for employers wishing to enroll in Group Health Cooperative health plans. Follow the steps below to accurately fill out the form online.

Follow the steps to successfully complete the application.

1. Click ‘Get Form’ button to obtain the form and access it in the editor.
2. Begin by reviewing Section 1, General Group Information. Fill in details such as your group's effective date, group number, legal name, and doing business as (if applicable). Provide the group’s physical and mailing address, along with contact information for the CEO or owner.
3. In Section 2, Employee Eligibility, specify your open enrollment months and define a bona fide employee's minimum working hours. Indicate when employees will be eligible for benefits and outline any rehire policies.
4. Proceed to Section 3, Group Participation. Here, provide figures including the total number of employees, those ineligible for enrollment, and the number of eligible employees actually enrolling.
5. In Section 4, COBRA/TEFRA/DEFRA, indicate whether your company falls under these regulations. In Section 5, address ERISA compliance and if your group is required to file IRS Form 5500.
6. Fill out Section 6 with information regarding any additional medical plans offered to employees. In Section 7, confirm rates and benefits selections, ensuring all supporting documents are attached.
7. In Section 8, review the Group Languages section and specify if there are any non-English languages spoken among participants. Complete Section 9 by providing details on your producer of record, if applicable.
8. Finalize your application in Section 10 by signing and dating the acknowledgements and certifications. Ensure all representations of coverage terms are accurate.
9. If you included a producer in Section 9, complete Section 11 by having the producer certify the information provided.
10. Once all sections are filled, save your changes. You can then download, print, or share the completed form as needed.

Complete your Group Master Application online today to ensure your group health coverage.