Cigna + oscar Enrollment Kits
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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 Cigna + Oscar's case submission requirements.
California Business Enrollment Form
California Employee Enrollment application(s)
Employee Waiver Form(s) and applicable waiver documentation.
DE9C unless there are seven (7) or more eligible enrolling employees with Cigna + Oscar.
Business Entity Document such as one issued by the Secretary of State.
ACH Authorization Form
Tax documents (see below)
In order to verify eligibility, Cigna + Oscar's underwriting team may request additional documentation above and beyond what is listed.
Keep in mind that the group's coverage will not begin until the application has been approved by Cigna + Oscar's Eligibility Team and payment has been received. Cigna + Oscar may request additional documentation, including payroll records and employee wage and tax filings, to determine a group's eligibility. Check payments may take up to 10 days to process.
PLEASE NOTE: Any eligible employee or dependent enrolled in Cigna + Oscar small group health coverage may not also be enrolled under an individual policy. The applicant must elect one or the other to avoid duplication of coverage.
Additional Required Enrollment Documents by Group Type
Sole Proprietorship
One of the following:
IRS Schedule C and 1040 Form (if owner is not listed on DE-9C)
IRS Schedule F and 1040 Form for Farms
Corporation
California Secretary of State active web confirmation, and one of the following:
Owner Affidavit
If owner is not listed on DE-9C, IRS Schedule K-1 (Form 1120-S) - include all K-1's totaling 100% ownership, IRS Form 1120 (pages 1-2), IRS Forms 1125-E or IRS Schedule G or a W-2
Additional proof of income for owner may be required if tax filings are not available due to length of time in business
NOTE: Corporations established out of state will also need to provide a Certificate of Qualification or Statement by Foreign Corporation in addition to the above documentation.
Partnership / Limited Liability Partnership (LLP)
If owner is not listed on DE-9C, recent IRS Schedule K-1 (Form 1065) - include all K-1's totaling 100% ownership, or Partnership Agreement & Tax ID Appointment Letter or W-2
NOTE: Corporations established out of state will also need to provide a Certificate of Qualification or Statement by Foreign Corporation in addition to the above documentation.
Limited Liability Company (LLC)
Statement of Organization with Operating Agreement
If owner is not listed on DE-9C, recent K-1 or other applicable tax filing document or W-2
Non-Profit Company
Most recent Quarterly Federal Tax Return (IRS Form 941), current payroll report, and one of the following:
IRS letter 501c3
IRS application for exempt status
California Secretary of State active web confirmation
National Federal Credit Union active web confirmation
Group who filed a consolidated tax return as an affiliated group
IRS Form 851, or a letter from a CPA
Churches
IRS Form 941
Payroll records form the prior 4 weeks
Seasonal industries
Prior four DE-9C reports
Spinoffs
4 weeks of payroll or DE-9C, and relevant employer documentation listed above depending on type of group
Startups
At least two (2) weeks of payroll prior to the effective date or DE9C, and relevant employer documentation listed above depending on type of group
Additional Tax Documents for Special Case Enrollees
New Hires not appearing on the most recent DE-9C
Most recent four-week payroll report and dates of hire for all New Hire employees
COBRA / Cal-COBRA Coverage Enrollees
Most recent DE-9C Form on which employees appeared, or bill from group's prior carrier listing COBRA/Cal-COBRA enrollees
Licensing: Broker appointment must be completed online via this link. NOTE: The group will not be approved until licensing is received.
| After approval, prior carrier termination letter must be submitted by the employer or broker. |