Small employer uniform employee application for group health insurance wisconsin 2025

1. Click ‘Get Form’ to open the small employer uniform employee application in the editor.
2. Begin by filling out the Employer Information section. Enter your Employer Name, Group Number, Division Number, and Employee Class. Specify the total number of permanent employees working 30 hours or more per week.
3. In the Employee Information section, print clearly using black or blue ink. Fill in your full name, Social Security Number, Birth Date, Sex, Height and Weight, and contact details including address and phone numbers.
4. Indicate your employment start date and average weekly hours worked. Select your marital status and provide any relevant details regarding previous marital events.
5. Choose the type of health coverage you are applying for from the options provided: Employee Only, Employee and Spouse, etc.
6. List all dependents applying for insurance in the Dependent Information section. Ensure to include their names, Social Security Numbers, birth dates, and other required details.
7. Complete the Medical Information section by answering all questions truthfully regarding current health conditions or treatments.
8. Review all sections for accuracy before submitting your application through our platform.

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