Underwriting Requirements

Group Eligibility

  • The group must be actively in business with a street address in one of the five Boroughs of NYC: Manhattan, Brooklyn, Queens, Bronx and Staten Island.
  • Eligible groups must have between 1 to 50 full time employees. Full time will be considered at least 30 hours per week. One employee group can be submitted only when accompanied by a waiver from the second eligible employee.
  • An officer of the company should provide written employment verification.
  • Easy Choice requires all enrolling subscribers to either reside or work in the contracted area: Manhattan, Queens, Brooklyn, Staten Island and Bronx.
  • Medicare recipients are eligible as long as they are full time workers.
  • Eligible dependents are defined as a legally married spouse or a legally dependent child up to the age of 26. Additional options for age 29 are also available.
  • Should Easy Choice determine that group information is materially false, we reserve the right to terminate or deny coverage.

Case Installation

  • To enroll a new case, all completed documents must be submitted to Easy Choice Health Plan of New York no later than the 27th of the month preceding the effective date.
  • Groups with incomplete information will not be enrolled until the proper information is supplied. In order to expedite the enrollment process; the following items must be included in the enrollment
  • • Social Security Number
    • Date(s) of birth
    • Complete Address
    • Date of marriage (if applicable)
    • Physician selection
    • Employment effective (start) date
    • Dependent information
    • Employer, as well as Employee, signature
  • Incomplete applications will be returned and may affect the requested effective date.
  • Groups enrolling 5 or more employees are allowed 2 plan options. Only one tier structure is allowed.

Required Documentation to Submit a Group

  • Group Agreement Form.
  • Signed check from the employer's business account.
  • Completed original employee enrollment forms or waivers for all eligible employees.
  • Applicable Quarterly wage and tax statements.( NYS45 )

  • Large Group
    In addition to requirements mentioned above, large group submission must have:

    • A group remittance agreement.

    All businesses with 2-50 (if there is only 1 eligible employee under the business the Sole Proprietor rates will apply) employees must supply the following tax documentation to Easy Choice:

    1. Most recent Quarterly Wage & Tax statement: NYS45
    2. If not required to file Wage & Tax Statement, we will require one of the following:
    Business Type
    If a "C" corporation Articles of incorporation, form 1120 (line 13 is wages) and Payroll Documents
    If a Church Form 941 (line 2 is wages) and payroll Documents
    If an LLC LLC agreement and the appropriate documentation noted above
    If a Partnership Partnership agreement, Form 1065 (line 9 is wages) and payroll documents
    If an "s" corporation Articles of incorporation, form 1120S (line 8 is wages) and payroll documents

    3. If the business has been in existence less than 1 year and has not filed a quarterly Wage and Tax Statement. Easy Choice will accept Corporation or Partnership papers and payroll documents, signed by the accountant/CPA of the firm.

    For additional information see also the Group Agreement Form, which includes:

    • Effective date and termination of agreement
    • Coverage
    • Eligibility
    • Notice
    • Premium Due date and payment
    • Premium Due date and adjustment
    • Premium Adjustments
    • Premium rate changes
    • Member effective dates of coverage
    • Ineligible members
    • Open enrollment periods
    • Responsibilities of group
    • Termination

    Required Documentation for Case Installation

    • Group Agreement Form
    • Sales Submission Form
    • Check for 1st month premium from the employer's business account
    • Fully completed original employee enrollment forms and waiver forms (if applicable). Faxes or copies are not acceptable
    • Quarterly wage and tax statements (NYS 45) for small groups

    Enrollment & Waiting Periods

    • Open enrollment will be held once a year on the group's anniversary or renewal date.
    • PLAN CHANGES. An official at the company should submit plan changes to Easy Choice Health Plan of New York no later than one month after initial enrollment. If no changes are made, the next period to change benefits will be during open enrollment.
    • New employees will be able to enroll in the plan on the first of the month following the plan's waiting period.
    • Employee waiting period can be no more than 90 days from the date of hire.
    • Employees who are terminated will be covered until the last day of the month in which the termination occurred. All terminations must be submitted either on a completed termination form or on company letterhead.
    • Those who decline coverage and subsequently wish to enroll without a qualifying event will only be eligible to enroll during the next annual open enrollment period. Qualifying Event: An unexpected event that will terminate an employee's participation in another health plan. An example of a qualifying event is the loss of coverage through a spouse losing a job.

    Policy Broker of Record Letter (BOR)

    • Commissions credit will be recognized for broker of record changes beginning the first of the month following the processing of the completed letter.
    • You can send the BOR to your General Agent who will then forward information to Easy Choice or you can mail it directly to:

      Easy Choice Health Plan of New York
      45 Broadway, Suite 300
      New York, NY 10006
      Attention: Sales Support & Installation

    • An authorized officer of the company must sign the letter.
    • All monthly commissions statements are mailed by the 25th of the month following the month in which the premium is received.
    • There are no retroactive BOR. Commissions will not be assigned on a retroactive basis, nor will commissions be paid retroactively.