Form preview

Get the free NEW JERSEY APPLICATION FOR A SMALL EMPLOYER FOR GROUP COVERAGE

Get Form
This document is an application form for small employers in New Jersey to apply for group life, disability, and dental insurance coverage through Aetna Life Insurance Company.
We are not affiliated with any brand or entity on this form

Get, Create, Make and Sign new jersey application for

Edit
Edit your new jersey application for form online
Type text, complete fillable fields, insert images, highlight or blackout data for discretion, add comments, and more.
Add
Add your legally-binding signature
Draw or type your signature, upload a signature image, or capture it with your digital camera.
Share
Share your form instantly
Email, fax, or share your new jersey application for form via URL. You can also download, print, or export forms to your preferred cloud storage service.

How to edit new jersey application for online

9.5
Ease of Setup
pdfFiller User Ratings on G2
9.0
Ease of Use
pdfFiller User Ratings on G2
To use our professional PDF editor, follow these steps:
1
Sign into your account. If you don't have a profile yet, click Start Free Trial and sign up for one.
2
Prepare a file. Use the Add New button to start a new project. Then, using your device, upload your file to the system by importing it from internal mail, the cloud, or adding its URL.
3
Edit new jersey application for. Add and change text, add new objects, move pages, add watermarks and page numbers, and more. Then click Done when you're done editing and go to the Documents tab to merge or split the file. If you want to lock or unlock the file, click the lock or unlock button.
4
Save your file. Select it from your list of records. Then, move your cursor to the right toolbar and choose one of the exporting options. You can save it in multiple formats, download it as a PDF, send it by email, or store it in the cloud, among other things.
With pdfFiller, it's always easy to work with documents. Try it!

Uncompromising security for your PDF editing and eSignature needs

Your private information is safe with pdfFiller. We employ end-to-end encryption, secure cloud storage, and advanced access control to protect your documents and maintain regulatory compliance.
GDPR
AICPA SOC 2
PCI
HIPAA
CCPA
FDA

How to fill out new jersey application for

Illustration

How to fill out NEW JERSEY APPLICATION FOR A SMALL EMPLOYER FOR GROUP COVERAGE

01
Obtain the New Jersey Application for a Small Employer for Group Coverage form.
02
Fill in your small business details, including the legal name, address, and tax identification number.
03
Provide information about the number of employees and their job titles.
04
Indicate the coverage start date and choose the type of plan you wish to apply for.
05
List all eligible employees who will be participating in the group coverage.
06
Ensure all necessary signatures are obtained from both the employer and the employees.
07
Submit the completed application to your insurance broker or directly to the insurance carrier.

Who needs NEW JERSEY APPLICATION FOR A SMALL EMPLOYER FOR GROUP COVERAGE?

01
Small business owners in New Jersey who want to provide health insurance coverage for their employees.
02
Employers looking to explore group health insurance options to attract and retain talent.
03
Companies with 2 to 50 employees that meet the criteria for small employer group coverage.
Fill form : Try Risk Free
Users Most Likely To Recommend - Summer 2025
Grid Leader in Small-Business - Summer 2025
High Performer - Summer 2025
Regional Leader - Summer 2025
Easiest To Do Business With - Summer 2025
Best Meets Requirements- Summer 2025
Rate the form
4.7
Satisfied
44 Votes

People Also Ask about

New Jersey defines a small employer as an employer with at least one but not more than 50 employees. Generally, small employers must satisfy participation and contribution requirements.
In New Jersey, full-time employment is typically considered to be between 30 and 40 hours per week. However, this is not defined by law and can vary depending on the industry. In some industries, 25 hours is considered a full-time week.
Overview of Small Employer Health Benefits Program The Small Employer Health Benefits Program (SEH Program) defines a small employer as an employer with at least one but not more than 50 employees.
The Small Employer Health Benefits (SEH) Program became operational in 1994 to ensure small employers: (1) have access to small group health benefits plans without regard to the occupation of the group, or the health status of any of the group's members; and (2) have the ability to renew the coverage from year to year
Employers are not required under state law to provide health or life insurance. However, it is still highly advised that you do so.
Eligibility. For goods and services contracts, small businesses with no more than 100 full-time employees must be registered in one of the following 3 categories: Small businesses whose gross revenues do not exceed $500,000. Small businesses whose gross revenues do not exceed $5 million.
(b) The Coverage Selection Forms shall contain a statement advising the insured or applicant that additional information concerning coverages or premiums is available by contacting the insurer or the producer.

For pdfFiller’s FAQs

Below is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

The New Jersey Application for a Small Employer for Group Coverage is a form used by small businesses in New Jersey to apply for health insurance coverage for their employees under state law.
Small employers with 2 to 50 eligible employees are required to file the New Jersey Application for a Small Employer for Group Coverage.
To fill out the application, employers must provide detailed information about their business, including the number of employees, type of coverage desired, and any prior coverage history, as well as complete the necessary sections of the form accurately.
The purpose of the application is to establish eligibility for small group health insurance coverage and to facilitate the enrollment process for small employers and their employees.
The application must report information such as the employer's name, business address, number of employees, health coverage options, and information regarding any previous group health coverage.
Fill out your new jersey application for online with pdfFiller!

pdfFiller is an end-to-end solution for managing, creating, and editing documents and forms in the cloud. Save time and hassle by preparing your tax forms online.

Get started now
Form preview
If you believe that this page should be taken down, please follow our DMCA take down process here .
This form may include fields for payment information. Data entered in these fields is not covered by PCI DSS compliance.