Small group submission

Health benefits that employees value

Small Group Information

In 2019 small group plans will be available in Barron, Buffalo, Chippewa, Crawford, Dunn, Eau Claire, Grant, Jackson, Juneau,La Crosse, Monroe, Pepin, Richland, Rusk, Sauk, Trempealeau, and Vernon Counties.

A small employer group is defined as an employer employing an average of not less than 2 or more than 50 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 50 employees on business days during the current calendar year. As used within this definition, employee shall mean any individual employed by the employer.

Download the 2018 small group brochure.

Information to submit for a small group plan

  1. Member Enrollment forms 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)
  2. Census of employees electing coverage using Health Tradition’s online rating system
  3. Small Employer Group Application PDF
  4. Complete list of all employees (Ins. 8.65(1), Wis. Adm. Code)
  5. Notice of Wisconsin Protections for Small Employer Groups (Ins. 8.44, Wis. Adm. Code) PDF
  6. Any eligible employee waiving coverage must complete and sign the waiver section (Ins 8.60, Wis. Adm. Code) of the Member Enrollment form
  7. 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)
  8. Disclosure of Rating Factors and Renewability Provisions (Ins. 8.48, Wis. Adm. Code) PDF
  9. First month’s premium.