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Atlantis Health Plan 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. (Faxes or copies are not acceptable)
- Health History form for all enrolling subscribers of small groups
- Applicable student verification form accompanied by original sealed document
from educational institution.
- Applicable Quarterly wage and tax statements
- Copy of current bill.
Large Group
In addition to requirements mentioned above, large group submission must have:
- A group remittance agreement.
- Claims experience.
- Electronic file of enrolling members.
All businesses with 2-50 employees must supply the following tax documentation to Atlantis Health Plan:
- Most recent Quarterly Wage & Tax statement: NYS45
- 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 |
- 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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