The "Purchaser" is the person placing the order, not necessarily the "Employer" listed in the plan document, or the person paying for it. Enter the name of the person that you would like us to contact if we have any questions about the order (i.e. Accountant, Agent, TPA, Payroll Company, or HR Mgr., etc.).
Enter the legal name of the Employer, EXACTLY as you would like to see it in your plan document. Do not type all in upper case or all in lower case; check your spelling and punctuation. If using a DBA, or the legal name includes a DBA, please include in the Notes the full legal name and which name you would like us to use as the common name in the documents.
Please enter the physical address of the Employer. If you have a P.O. Box or alternate address that you would like the document mailed to, this may be entered in the Notes or on the credit card payment form.
Please Provide your Business Information. Form of business, state of incorporation, and FEIN Required. Must be nine digits XX-XXXXXXX, this is not the owner's SSN.
If another company is owned by this Employer, and they want to include the other company's employees in this benefit, add it as an Affiliate Company. Please print legal name exactly as you would like it to appear in the document. Include FEIN in the Notes.
The Plan Administrator is typically the Employer. Unless there is a specific entity that you would like designated as Plan Administrator, you may leave the Plan Administrator fields blank.If the Plan requires submission of Claims, this Fax # will be included on the Claim Form.
Reimbursement of (non-employer sponsored) Individual Health Insurance can only be reimbursed post-tax, all other employer sponsored group health plan premiums can be pre-taxed. Group Term Life Insurance can be pre-taxed for the Employee only, and limited to the first $50,000 of face value.
Other types of insurance may include Specified Illness, Critical Care, and other eligible health and accident policies.
If you have never provided this benefit before, choose New Plan - A and enter first date of pay period when benefit will begin.If you began giving this benefit to your Employees more than three months ago, chose an Amended Plan - give dates for B and C.
In most cases, the Plan Year will be January 1, through December 31. Or the Plan Year can coincide with the Employer Health Plan, however the Employer may choose any twelve month period.
Minimum = 1
Maximum = 40
Please enter the number of days of employment before employee eligibility.
Minimum = First day of Employment.
Typical = First day of month after 30, 60 or 90 consecutive days of employment.
If you offer group health insurance youíre now required by ERISA law, enforced by the Department of Labor and now the Affordable Care Act, to distribute a Wrap SPD within 120 days of the Planís effective date. Failure to provide the Wrap SPD within 30 days of request triggers a $110 a day fine per participant. Not having a Wrap SPD can also trigger an audit by the Department of Labor. The insurance companyís Master Contract, Certificate of Coverage, or Summary of Benefits is not a Wrap SPD. This requirement applies to all employer sponsored group health insurance offerings, including a one-person plan. See our Wrap SPD webpage in the blue drop down menu for more information.
Please take a moment to provide some feedback on your experience.