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This document is an application and enrollment form for the HumanaDental Insurance Company, specifically designed for small groups and individuals in California with 1-100 employees. It includes sections for personal information, prior coverage details, and eligibility for enrollment based on specific qualifying events such as new hires, COBRA exhaustion, or loss of coverage.
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Gather all necessary employee information such as name, position, and department.
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Small group employee refers to a classification of employees working within a business that has a limited number of employees, typically defined as having fewer than 50 full-time employees.
Employers with a small group of employees, generally consisting of less than 50 full-time employees, are required to file small group employee forms.
To fill out the small group employee form, employers must provide relevant employer and employee information, including names, addresses, Social Security numbers, and details about the health insurance coverage offered.
The purpose of the small group employee form is to report information related to health insurance coverage provided to employees and to ensure compliance with federal and state regulations.
The information that must be reported includes employer details, employee details, insurance plan information, and coverage periods.
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