KBenefits
Insurance - Medicare - Retirement

Small Group Enrollment

Carriers require the following enrollment documentation to determine eligibility and approval. Depending on the carrier and the size of your group, certain additional documentation may or may not required.  

Required Forms and Documents:

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

2)  Binder check payable to the carrier:   Checks get sent to me.

Binder Checks Get Mail to:

Chris Kudryk, KBenefits
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

KB Services
KB Brochure.pdf
Adobe Acrobat document [316.5 KB]

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

 

 

Healthcare.gov
Chris Kudryk
NPN: #7990501

 

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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