Enrollment Kit - cCHP (medical)
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This checklist is provided as a guide. The carrier may require additional items and documentation. Please refer to the carrier's underwriting guidelines for a complete list of requirements. Please use the latest version of forms.
Our goal is to process your new group enrollment easily and efficiently in order to provide you and your client with a quick approval. The following list outlines Chinese Community Health Plan's case submission requirements.
To ensure prompt processing, please make sure to include the following documents:
All documents below must be submitted at the time of application.
A signed original Employer Master Group Application - Effective 1/1/2024
If a broker is involved, please complete Section 10 of the Master Group Application.
- A copy (all pages) of the most recent state Quarterly Wage and Tax Report (DE9C).
T Terminated (including termination date) PT Part-Time
E Eligible and enrolling WP Waiting Period (Include Date of Hire)
W Eligible and waving coverage TEMP Temporary Employee
S Seasonal
For all employees who do not appear on the current DE9C, a copy of the most recent payroll is required.
Proof of Worker's Compensation.
- If the group has not been in business long enough to have a DE9C, six weeks of payroll, including withholdings, may be submitted.
- A copy of the current carrier's most recent billing statement (all pages). If applicable, Employees appearing on the current bill with a reported termination date of 90 days or greater will be required a COBRA application or waiver form to be completed as verification of their eligibility to continue or decline coverage.
- Enrollment forms completed and signed by all eligible employee(s) enrolling or waiving coverage.
- If Medicare is primary, a copy of each employee's Medicare card is required to verify enrollment in parts A and B. A copy of the Medicare card is also required to confirm participation requirements.
- First-Month premium check made payable to: Balance by CCHP.
By mail to: OR
Balance Sales Department Submit via your Agent/Broker
445 Grant Avenue
San Francisco, CA 94108
Proof of Ownership/Company Structure:
Required for groups of any size. This document is used to verify the prospective client is a legitimate, active Small Group eligible for coverage. The information is also used to verify an Owner, Officer, or Partner is actively engaged in the business eligible for coverage. Balance may conduct online searches to validate filings and other documentation. Balance may decline a group for coverage if a search is not successful.
Sole Proprietorship:
Most recent IRS Schedule C (Form 1040) or
California Business License, or
Fictitious Business Name Statement, if any
Partnership and Sole Proprietorship (Individual & Husband/Wife):
Businesses must have minimum of one (1) DE9C/employee on the payroll.
Partnerships where the only employees are the partners themselves do not qualify for small group coverage
- Partnerships where the only employees are the partners and/or the spouse of the partners do not qualify for small group coverage
- Sole Proprietors where the only employee is the sole proprietor do not qualify for small group coverage
- Sole proprietors where the only employee(s) is the sole proprietor and/or its spouse do not qualify for small group coverage
Partnership:
IRS Schedule K-1 (Form 1065) for all enrolling partners, or
Partnership Agreement signed by each partner plus a federal EIN assignment letter
Corporation:
S-Corps: IRS Schedule K-1 (Form 1120S) for all enrolling owners/officers.
- C-Corps: IRS Form 1120 (pages 1 & 2) which includes "Schedule E"
- Statement of Information (Form LLC-12)
LLC:
- LLC Agreement signed by all managers/members/parties or copies of appropriate tax returns (follow the guidelines for an S-Corp, Partnership or Sole Proprietorship based on how the LLC was formed), or
- Statement of Information (Form LLC - 12)
New/Start-up Businesses typically may meet all the underwriting requirements with the exception of the length of time they have been in business. Balance will consider groups that have been in business for at least (6) weeks but retain the right to defer the group until the California Small Group requirements have been met. To obtain approval for a New/Start-up Business, the following may be required:
- Payroll records or applicable filings indicating the length of time the group has been in business. These documents must span the twelve (12) weeks preceding the effective date and demonstrate one or more eligible employees for the entire period. Payroll records must include all pages for all pay periods and list the following:
- Company Name
- Type of Company (see above)
- Date of pay periods
- Employee Names, wages paid, withholdings, and grand totals
- Individual payroll/pay stubs, estimated payroll, payroll summaries, or handwritten journals are not deemed acceptable.
| After approval, prior carrier termination letter must be submitted by the employer or broker. |
For other useful or older documents, please refer to the Forms database.