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Enrollment Census: Employers
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To Download and Edit:
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Click "File", then "Download", finally download as an excel (.xlsx)
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Instructions: Employee Benefits
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1. All blue highlighted fields are required. Black is optional for additional coverages.
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2. Every employee must be listed on the census: Full-time employees, Part-Time employees, and employees still in the waiting period.
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3. Employee dependents must be listed below the Employee to whom they relate.
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4. "Plan Enrolled" should indicate which plan the employee is enrolled in. You do not need to indicate depenedent plans, because they're the same as the employee. If the employee doesn't enroll, indicate "Waive".
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5. Please provide copies of the premiums, renewals, contributions, and plan designs for your active plans.
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6. Eligible Employees are defined as an employee working 30 or more hours per week on an average basis.
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7. Quotes are based on the census data received. Actual costs are based on the final enrollment data of employees and dependents insured on the plans effective date, and subject to carrier approval.
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8. If you're interested in the Wellness Program / 401(k), please be prepared to provide additional payroll reports. We will provide specific reports based on your payroll vendor.
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9. This census doesn't imply coverage. All data is HIPPA compliant and confidential.
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To Download and Edit:
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Click "File", then "Download", finally download as an excel (.xlsx)
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