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Individual Application Submit completed application to: Common Ground Healthcare Cooperative 120 Bishops Way, Suite 150 Brookfield, WI 530056271 EFFECTIVE DATE*:*If enrolling during Open Enrollment,

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How to fill out small group employee application

01

Obtain a copy of the small group employee application form from your employer or human resources department.

02

Fill out your personal information including your name, address, phone number, and email address.

03

Provide information about your employment history, including previous employers, job titles, and dates of employment.

04

Fill out details about your current job, including your position, salary, and any benefits you receive.

05

Sign and date the application form to confirm that all information provided is accurate and complete.

Who needs small group employee application?

01

Small group employee application is needed by individuals who are applying for a job within a small group or company.

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What is small group employee application?

A small group employee application is a form used by small businesses to enroll their employees in a group health insurance plan. It collects necessary information about the business and its employees to facilitate coverage.

Who is required to file small group employee application?

Employers with a certain number of employees, typically between 2 to 50, who wish to provide health insurance coverage to their staff are required to file a small group employee application.

How to fill out small group employee application?

To fill out a small group employee application, employers must provide details about their business, including the number of employees, information about the health insurance plan they intend to offer, and personal information for each employee seeking coverage.

What is the purpose of small group employee application?

The purpose of the small group employee application is to collect necessary information to determine eligibility and to enroll small businesses and their employees in a group health insurance plan.

What information must be reported on small group employee application?

The application must report information such as the business's name and address, the number of employees, employee names and details, the selected health insurance plan, and contact information.

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