KBenefits Insurance Services
Insurance - Medicare - Retirement

Small Group Health Insurance
Carrier Requirements for Enrollment


Carriers require the following documentation in order to determine eligibility and approval your groups enrollment.  These are the typical documents that are required in a typical enrollment.  Depending on the carrier and the size of your group, certain additional documentation may or may not required.  


  • Employer Enrollment Form
  • Employee Enrollment Forms
  • Employer Certification
  • Waivers
  • Signed Rates
  • Binder Check: Company check 1st month premium
  •  WR-30 - Quarterly Tax & Wage form
  •  Owners Tax docs - Schedule C, K-1 or 1120
  • Personal 1040 tax form, and W-2 if there's income on line #7 - (some carriers)


  Examples of Business tax documentation and Personal tax documentation.

Schedule K-1
Portable network image format [166.2 KB]
Schedule C/1040
Schedule C 1040.jpg
JPG image [568.0 KB]
Form 1120s
1120 form.gif
Graphic interchange format [127.5 KB]
Personal 1040 Indiv income tax
Personal 1040 - indiv income tax form.jp[...]
JPG image [230.7 KB]

KBenefits, LLC
Christopher S. Kudryk

Call:  732-333-1976
Fax:   732-444-5971


Broker/Agent Info:
NPN: #7990501


KBenefits insurance services provide solutions for small business owners and individuals in New Jersey & New York.  Contact KBenefits today and see how we can benefit you.

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