Employer Eligibility Q&A for Health Benefit Registration

Employer Eligibility Q&A for Health Benefit Registration

Answer the eligibility questions to register your employee group for a health benefit program.
Company Name
Contact Person Full Name

First NameLast Name
Contact Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Company Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
How many W-2 employees does the company currently have
Type of Business
Of those employees how many earn at least $25,000 per year
How many of those employees generally work over 30 hr. or more per week
Do you currently offer any health benefits to your employees?
does the company have multiple locations or related comp.
If so, approximately how many qualifying W-2 employees are there across the organization.
what kind of payroll company or payroll system does the company use
Are the employees located in one state or multiple states?
Who else beside you should be included in a brief Zoom presentation
Should be Empty: