Large group submission

Large group plans are available in:

Eastern Wisconsin

Brown, Calumet, Door, Fond du Lac, Green Lake, Jefferson, Kenosha, Kewaunee, Manitowoc, Marinette, Marquette, Menominee, Milwaukee, Oconto, Outagamie, Ozaukee, Racine, Shawano, Sheboygan, Walworth, Washington, Waukesha, Waupaca, Waushara, and Winnebago counties.

Western Wisconsin

Adams, Ashland, Barron, Bayfield, Buffalo, Burnett, Chippewa, Crawford, Douglas, Dunn, Eau Claire, Grant, Jackson, Juneau, La Crosse, Monroe, Pepin, Pierce, Polk, Richland, Rusk, Sauk, St. Croix, Trempealeau, Vernon, and Washburn 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. Health Tradition Health Questionnaire PDF or 2 Years of Claim Experience
  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.