Get Copower One Employer Application

Completing the CoPower ONE Employer Application online is essential for ensuring your organization can access the required benefits. This guide provides a clear and structured approach to filling out the application, tailored for users of all experience levels.

Follow the steps to successfully complete your employer application.

1. Click the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Begin by entering your employer information: Fill in the company name and any 'Doing Business As' (DBA) name. Enter the street address, city, state, and zip code of your business, as well as the billing address if it differs from the company address.
3. Indicate the type of employer you are by selecting from the options provided (partnership, corporation, public agency, etc.) and provide your SIC code.
4. Specify the date your business was established and include your Tax ID number along with the contact person's name, title, email, and phone number.
5. Select your preferred method of communication: mail, email, or fax, and provide the requested effective date for insurance coverage.
6. In the group eligibility information section, list the total number of employees and total number of eligible employees. Also, provide details about previous dental carriers and cancellation dates.
7. Indicate if the waiting period is waived for initial enrollment and specify when eligibility begins by selecting from the options provided.
8. Address questions regarding Union or Non-Union status, COBRA, and Sec. 125 or POP plans, ensuring to answer as accurately as possible.
9. Choose the appropriate plan types for dental coverage and life insurance as per your organization’s needs.
10. Complete the payment section by opting for the initial payment method and specifying if you want automated monthly debits from your bank account.
11. Finally, review the application for accuracy, sign to verify that all information is correct, and indicate the date of signing. Include the required signatures from any necessary representatives and producers.
12. Once completed, save your changes, download, print or share the form as needed.

Complete your CoPower ONE Employer Application online today to ensure your organization’s benefits are seamlessly managed.