Large group submission


Large group plans are available in:

Available in Barron, Buffalo, Chippewa, Crawford, Dunn, Eau Claire, Grant, Jackson, Juneau, La Crosse, Monroe, Pepin, Richland, Rusk, Sauk, Trempealeau, and Vernon Counties.


 

Complete paperwork for an underwritten rate includes:

  1. A Proposal Request Form PDF
  2. Complete Employer Census (age or date of birth, gender, election type, zip code)
  3. 2 Years of Claim Experience or Health Tradition health questionnaire from all eligible employees
  4. Current Summary of Benefits and Plan Design

Information required for final large group benefit set-up:

  1. Large Employer Group Application PDF
  2. Member Enrollment Form PDF for each eligible employee electing coverage. The form contains a Waiver Section on page 2; any eligible employee waiving coverage must complete and sign the waiver section (Ins 8.60, Wis. Adm. Code)
  3. 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)
  4. First month’s premium.