2021-22 Employer Data Sheet Preview on Page 1

2021-22 Employer Data Sheet-2026

The document is a worksheet for the 2021-22 Employer Data Sheet related to The Local Choice Program, outlining the process and requirements for employers to submit their data for health insurance renewals. It includes deadlines for submission, instructions on classifications of employees, election rules, participation counts, plan selections, premium contributions, ACA reporting, open enrollment dates, and contact information. Employers are encouraged to use the worksheet to gather necessary information before completing the online form.

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Click ‘Get Form’ to open the 2021-22 Employer Data Sheet in our platform.
Begin by entering your group name and selecting whether it is an existing or new group. Ensure you provide the correct Group ID and FEIN.
In the Classifications section, check 'yes' or 'no' for each enrollee category and select the appropriate billing method where applicable.
For Election Rules, choose your initial enrollment waiting period and specify the number of days allowed for election changes due to qualifying mid-year events.
Enter participation counts for each group ID, ensuring you sum totals accurately to determine participation percentages.
Select plan choices and enter employer contribution amounts. Be sure to indicate if premium averaging is used.
Complete the ACA Reporting section, confirming DHRM will file reports on your behalf if applicable.
Set your Open Enrollment dates within the specified parameters, ensuring they do not exceed 30 days.
Fill in contact information for all relevant administrators, ensuring accuracy for communication purposes.
Finally, certify that all information provided is true and complete before submitting your form through our editor.

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