Small group submission

Requirements

A small employer group is defined as an employer employing an average of not less than 2 or more than 49 employees on business days during the preceding calendar year. If the employer was not in existence during the preceding calendar year, it will qualify as a small employer group if it reasonably expects to employ an average of at least 2 but no more than 49 employees on business days during the current calendar year. As used within this definition, employee shall mean any individual employed by the employer.

Initial paperwork to obtain underwritten quotes for small groups:

The sales person (agent, broker or Health Tradition internal sales personnel) must submit complete paperwork to Health Tradition Sales and Marketing Associate for a prospective client prior to the 1st of the month, for a 1st of the month effective date.

  1. Small Employer Uniform Employee Application for Group Health Ins. (OCI 26-501) is delivered in a confidential stamped envelope for each person electing coverage:  Small Employer Uniform Employee ApplicationPDF
  2. Rating at Tier 1PDF
  3. Benefit Request Form
  4. Signed and dated Disclosure of Rating Factors and Renewability Provisions FormPDF

Before a small employer completes an application for a policy, Health Tradition Health Plan and its agents must obtain a dated, authorized signature for the Disclosure of Rating Factors and Renewability Provisions form.

Final additional paperwork required for group set-up (Small Group):

If the group elects coverage with Health Tradition, completed paperwork must be submitted to the Sales and Marketing Associate by the 10th of the month to have an effective date of the 1st of the month.

Completed paperwork includes the following (see forms):

  1. Employer Group Master Contract PDF (POS Contract if applicable PDF)
  2. Small Employer Group Application PDF
  3. Complete list of all employees (Ins. 8.65(1), Wis. Adm. Code)
  4. Notice of Wisconsin Protections for Small Employer Groups (Ins. 8.44, Wis. Adm. Code) PDF
  5. Any eligible employee waiving coverage must complete and sign the waiver section (Ins 8.60, Wis. Adm. Code) of the Small Employer Uniform Employee Application for Group Health Insurance
  6. Most recent Wage & Tax statement with notes of terminated, part-time and/or seasonal workers. If no Wage & Tax statement, copies of W2’s or Income Tax return. (Ins. 8.65, Wis. Adm. Code)
  7. Disclosure of Rating Factors and Renewability Provisions (Ins. 8.48, Wis. Adm. Code) PDF See letter A (4).
  8. First month’s premium.

If any of the above forms are missing or incomplete, paperwork is not considered complete and will be held for complete forms, which may result in a later effective date for the group.