Get the free Massachusetts Small Employer Certification Form - ConnectiCare

Massachusetts Small Employer Certification Form Pursuant to Massachusetts provision of Chapter 176J of Insurance laws, carriers doing business in the small employer market in the State of Massachusetts

How to fill out massachusetts small employer certification

How to fill out Massachusetts small employer certification:

1. Download the Massachusetts small employer certification form from the official website of the Massachusetts Department of Unemployment Assistance.
2. Fill out the employer information section, including the business name, address, Federal Employer Identification Number (FEIN), and contact details.
3. Provide details about the insurance coverage being offered to the employees, such as the name of the insurance carrier, type of plan, and the effective date of coverage.
4. Indicate whether the employer intends to continue offering coverage to their employees in the future.
5. Sign and date the certification form, confirming that the information provided is accurate and true to the best of your knowledge.

Who needs Massachusetts small employer certification?

1. Employers in Massachusetts who have 11 or more full-time-equivalent employees in any calendar quarter of the previous year are required to complete the Massachusetts small employer certification.
2. This certification is necessary if the employer wants to claim a hardship exemption from the Employer Medical Assistance Contribution (EMAC) Supplement, or if they want to be eligible for the small employer exemption from the Paid Family and Medical Leave (PFML) law.

Note: It is always recommended to consult the official guidelines and regulations provided by the Massachusetts Department of Unemployment Assistance to ensure accurate and up-to-date information when filling out any certification forms.

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What is massachusetts small employer certification?

Massachusetts small employer certification is a form required by the state to verify that a business is eligible for small employer health insurance programs.

Who is required to file massachusetts small employer certification?

Small businesses with eligible employees who want to participate in health insurance programs in Massachusetts.

How to fill out massachusetts small employer certification?

Massachusetts small employer certification can be filled out online through the state's official website or by submitting a paper form by mail.

What is the purpose of massachusetts small employer certification?

The purpose of Massachusetts small employer certification is to ensure that businesses meet the eligibility criteria for small employer health insurance programs.

What information must be reported on massachusetts small employer certification?

Information such as business details, number of eligible employees, and intent to participate in health insurance programs must be reported on Massachusetts small employer certification.