2021 WA Small Group Employer Application Preview on Page 1

2021 WA Small Group Employer Application-2026

The document is an employer application for small group health coverage through Kaiser Foundation Health Plan of the Northwest. It outlines the necessary information required from businesses, including legal name, address, employee count, medical coverage details, and eligibility criteria. The application also addresses topics such as workers' compensation, domestic partner coverage, ERISA status, premium contributions, and benefit offerings. It emphasizes that no contract will exist until the application is reviewed and accepted by Kaiser Permanente.

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Click ‘Get Form’ to open the 2021 WA Small Group Employer Application in our editor.
Begin by filling out the 'About Business' section. Enter your legal business name, physical address, and contact information. Ensure that all details match your official documents.
In the 'Other Medical Coverage' section, indicate whether your company has had group coverage through Kaiser Permanente. If yes, provide the group ID and company name.
Proceed to 'Employer Eligibility' and answer questions regarding affiliations with other companies and employee counts. This is crucial for determining your eligibility for small group coverage.
Complete the 'Employer Premium Contribution' section by selecting your contribution percentage or fixed dollar amount towards employee coverage.
Finally, review the 'Agreement and Signature' section. Ensure all information is accurate before signing digitally within our platform.

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Versions	Form popularity	Fillable & printable
2021	4.8 Satisfied (90 Votes)
2019	4.4 Satisfied (50 Votes)

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