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721 South Parker, Suite 200 Orange, CA 92868 (800) 558-8003 FAX (714) 558-8000 Employer Change Request Form Group Name CaliforniaChoice Group # **OPEN ENROLLMENT ONLY** ? Changes below are only allowed
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How to fill out californiachoice employer change request
How to fill out californiachoice employer change request:
01
Go to the californiachoice website and locate the employer change request form.
02
Fill in your company's basic information such as name, address, and contact details.
03
Provide the effective date of the change and specify the type of change you are requesting (e.g., adding new employees, removing employees, changing plan options, etc.).
04
Indicate the reason for the change and provide any additional details or documentation required.
05
Review the form for accuracy and completeness before submitting it.
06
Sign and date the form and make a copy for your records.
Who needs californiachoice employer change request:
01
Employers who are enrolled in the californiachoice program and need to make changes to their current plan or employee coverage.
02
Employers who are hiring new employees and need to add them to their californiachoice plan.
03
Employers who are terminating or removing employees from their californiachoice plan.
04
Employers who want to make changes to their plan options, such as switching to a different insurance carrier or modifying the coverage levels.
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What is californiachoice employer change request?
Californiachoice employer change request is a form used to make changes to the employer's healthcare coverage options.
Who is required to file californiachoice employer change request?
Employers who offer healthcare coverage through Californiachoice are required to file the employer change request.
How to fill out californiachoice employer change request?
The employer must provide information about the requested changes, employee demographics, and the effective date of the changes on the form.
What is the purpose of californiachoice employer change request?
The purpose of the request is to update or modify the employer's healthcare coverage options for their employees.
What information must be reported on californiachoice employer change request?
Information such as employee demographics, requested changes, effective date of changes, and any other relevant details must be reported on the form.
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