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| Group Census Form - Employee Benefits |
Please fill out this form to request a group health/dental/life quote. For those groups over 10, please call 850-434-8123
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Participation/Documentation Requirements Please note that carriers require approximately75% participation (enrollment) of eligible employees. Eligible employees are employees who work more than 25 hours per week and do not have other creditable coverage (ex., coverage through a spouse, Cobra, or Medicaid). Those employees are eligible to waive coverage under a qualified waiver. Individuals with personal health insurance policies are not eligible to waive group coverage and if they do so, it is considered a non-qualified waiver. 1099 employees may be eligible to enroll with documentation. Carriers require that employers contribute a minimum of 50% of the employee only premium.
Documentation required for group coverage is usually a UCT-6 and IRS 941. There are some exceptions. All paperwork and documentation must be submitted the first of the month prior to the requested effective date.
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