KBenefits Insurance Services
Group Health 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 be requested in order to determine eligiblity.

Enrollment Requirements:

  1. Group Enrollment App
  2. Employer Certification
  3. Employee Enrollment App(s)
  4. Waiver Forms
  5. Final Rates - signed
  6. Binder Check:  Company check for 1st month's premium
  7. AutoPay - recommended


  1. WR-30 payroll form - (quarterly tax & wage form)
  2. Owners Tax docs:  Either K-1 or Schedule C. 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
JPG image [568.0 KB]
1120 Form
1120 form.gif
Graphic interchange format [127.5 KB]

Carrier Applications

Horizon BCBS - Group App
2021 - SG enrollment (ALL).pdf
Adobe Acrobat document [1'022.5 KB]
Horizon BCBS - Enrollment App
22 - EE Enrollment app.pdf
Adobe Acrobat document [2.3 MB]
Horizon BCBS - Autopay Form
AutoPay - Small Group.pdf
Adobe Acrobat document [29.8 KB]

Contact us for questions, plan options and free enrollment assistance.

Christopher S. Kudryk

KBenefits Insurance Services
Health - Life - Medicare

Christopher S. Kudryk
Insurance Specialist

KBenefits Insurance Services provides insurance solutions for small business owners and individuals in New Jersey, New York, Pennsylvannia & Florida..

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