Group Enrollment

Small Group Health Insurance

Enrollment Requirements

Once your are ready to enroll your group into a small business health plan, carriers require the following enrollment documents.  Depending on the carrier and the size of your group, additional documentation may or requested in order to determine eligiblity.

Enrollment Requirements:

  1. Group Enrollment Form
  2. Employee Enrollment Forms
  3. Employer Certification Form
  4. Waiver Forms, if applicable
  5. Signed Rates
  6. Binder Check:  Company check for 1st month's premium


  1. WR-30 payroll form - (quarterly tax & wage form)
  2. Owners Tax docs:  Either K-1, Schedule C and/or 1120 form. showing 100% ownership

Examples of Owners Tax Forms: 
Provide one of the following, showing 100% ownership:

Schedule K-1
Portable network image format [166.2 KB]
Schedule C
Schedule C 1040.jpg
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1120 Form
1120 form.gif
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Personal 1040 - Indiv income tax
MHP requires Personal 1040 tax form and W-2*
Personal 1040 - indiv income tax form.jp[...]
JPG image [230.7 KB]

Where To Send The Documents:

Send to:
1)  Forms and documents can be emailed or faxed.  chris@kbenefits.com / 732-444-5971

2)  Binder check payable to the carrier:

Binder checks mail to:  (payable to the carrier)
Chris Kudryk,
KBenefits, llc
13 Mead Ave, Freehold, NJ  07728

Enrollment Time Line: 
Once all forms and documents have been collected and submitted to the carrier.  The carrier will take 5-12 business days to review and approve the policy for activation.  Once approved, ID numbers will be provided and ID cards will be mailed out and recvd within 12 business days.  ID cards can also be obtained online on your carriers' Member Portal

KBenefits, LLC
Christopher S. Kudryk
Call:  732-333-1976
Fax:   732-444-5971




Chris Kudryk


KBenefits provides insurance solutions for small business owners and individuals in NJ & NY.  Contact KBenefits today and see how we can benefit you.

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