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Enrollment Form SMALL GROUP SUBSCRIBER 1. GROUP INFORMATION Group Name Group Number (if available) 2. SUBSCRIBER INFORMATION Last Name First Name: M.I. Gender o Female o Male Date of Birth (mm/dd/by)

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What is health republic small group?

Health Republic Small Group refers to the health insurance plans available for small businesses who want to provide health coverage for their employees.

Who is required to file health republic small group?

Small businesses with a certain number of employees are required to file health republic small group plans.

How to fill out health republic small group?

Health republic small group plans can be filled out online through the insurance provider's website or through a licensed insurance broker.

What is the purpose of health republic small group?

The purpose of health republic small group is to provide affordable health insurance options for small businesses and their employees.

What information must be reported on health republic small group?

Information such as employee names, dependent information, coverage details, and premium payments must be reported on health republic small group plans.

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