1 New Business Small Employer Application - Rogers Benefit Group 2026

1. Click ‘Get Form’ to open the application in our editor.
2. Begin by entering the Group Information. Fill in the full legal name of your business, any 'Doing Business As' names, and the nature of your business along with the SIC code.
3. Next, select your Employer Classification (Corporation, Partnership, Sole Proprietor, or Other) and provide the physical address of your group.
4. Complete the Decision Maker's name and title, along with contact details including phone number and email.
5. Fill out the Eligibility Information section. Specify employer contributions for employees and dependents, waiting periods, and how new eligible employees will be added.
6. Provide information regarding your Workers’ Compensation Carrier and prior health insurance carrier. Ensure all required fields are completed accurately.
7. Review all sections for accuracy before submitting. Use our platform’s features to save or share your completed application as needed.

Start filling out your application today using our platform for a seamless experience!