KBenefits Insurance Services
Group Health Insurance

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 Application
  2. Employee Enrollment Application
  3. Employer Certification Application
  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 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]
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)  Email forms and documents to:  chris@kbenefits.com
or Faxed to:   732-444-5971


2)  Binder check payable to the carrier for 1st month's premium.

Binder checks get emailed then mail to me:  (payable to the carrier)
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 Approval. 

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

Christopher S. Kudryk
Insurance Specialist

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

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