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SMALL GROUP BUSINESS APPLICATION(For small employers headquartered in the 13 counties of Northeastern Pennsylvania) I. GROUP SUBMISSION q New Business Other (e.g., Ownership, Office Benefit, Subsidiary

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What is new providers can submit?

New providers can submit updated contact information, qualifications, and scope of services.

Who is required to file new providers can submit?

All new providers are required to file new providers can submit.

How to fill out new providers can submit?

To fill out the new providers can submit form, providers must provide accurate and up-to-date information.

What is the purpose of new providers can submit?

The purpose of new providers can submit is to ensure that all providers have current information on file and are able to offer services.

What information must be reported on new providers can submit?

New providers must report their contact information, qualifications, and the services they offer.

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