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Atlantis Health Plan Required Documentation to Submit a Group

  1. Group Agreement Form.
  2. Signed check from the employer's business account.
  3. Completed original employee enrollment forms or waivers for all eligible employees. (Faxes or copies are not acceptable)
  4. Health History form for all enrolling subscribers of small groups
  5. Applicable student verification form accompanied by original sealed document from educational institution.
  6. Applicable Quarterly wage and tax statements
  7. Copy of current bill.
Large Group

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

  1. A group remittance agreement.
  2. Claims experience.
  3. Electronic file of enrolling members.
All businesses with 2-50 employees must supply the following tax documentation to Atlantis Health Plan:
  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 Requirements
    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
    If a sole proprietor Business license, form 1040/Schedule C (line 26 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, Atlantis Health Plan will accept Corporation or Partnership papers and payroll documents, signed by the accountant/CPA of the firm.
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