Get Form Ssa 1372 Bk

Filling out the Form Ssa 1372 Bk online can streamline the process of establishing a Premium Only Plan. This guide will provide clear, step-by-step instructions to empower you as you complete this important document.

Follow the steps to successfully complete the Form Ssa 1372 Bk.

1. Click the ‘Get Form’ button to access the form and open it in your online editor.
2. In Section 1, provide your company information. Ensure you enter the full legal business name, contact number, street address, city, state, and zip code. Additionally, include the Employer’s Taxpayer Identification Number and the State of Organization or Incorporation.
3. Fill in the contact information in Section 2. Include the primary contact's name, phone number, title, and email. If applicable, add an additional day-to-day contact and the lead broker contact details.
4. In Section 3, enter the Health & Welfare Plan number and select whether this is a new POP, renewal POP, or a restatement of a previous plan. Specify the effective date and plan year dates if applicable.
5. Choose between the Basic or Comprehensive POP options, noting the respective setup fees and features associated with each.
6. Specify the types of insurance plans offered through the Premium Conversion Account and fill out the eligibility requirements for employees. Ensure you provide accurate details for contributions and participation conditions.
7. Review your information for accuracy. Once all sections are completed, save your changes and proceed to download, print, or share the form as needed.

Complete your documents online today for a streamlined process.