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:
- A Proposal Request Form
- Complete Employer Census (age or date of birth, gender, election type, zip code)
- 2 Years of Claim Experience or Health Tradition health questionnaire from all eligible employees
- Current Summary of Benefits and Plan Design
Information required for final large group benefit set-up:
- Large Employer Group Application
- Member Enrollment Form 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)
- 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)
- First month’s premium.