Common use of Employee Participation Requirements Clause in Contracts

Employee Participation Requirements. Medical: at least 75% of Eligible Persons* must enroll. • Dental and Vision: 100% of Eligible Persons* must enroll. • Life and Long‐Term Disability: 100% of full‐time employees must enroll. Required Forms: • Signatures cannot be dated more than 59 days prior to the requested effective date. • Enrollment and Change Form must be completed by each full‐time employee when: o Enrolling in Medical, Dental, Vision, Group Life or Long‐Term Disability. o Waiving or terminating coverage for themselves and/or dependents. • All former employees applying for COBRA/Cal‐COBRA coverage must complete the COBRA/Cal‐COBRA section of the Enrollment Form • Beneficiary Designation Forms must be completed for Life and Long‐Term Disability. • Evidence of Insurability Information is required for groups of 2‐3 employees applying for Life and/or LTD coverage. • All groups must submit a copy of their most recent DE‐9 and DE‐9c. • HSA Administration form must be completed for groups electing integrated HSA administration. Missing signatures and questions left unanswered can delay the processing of your application. If you have any questions regarding or need assistance with reviewing the Subscription Agreement, please call Banyan Administrators – Managers for the CalCPA Health Programs at 877‐480‐7923. Once all questions have been answered, please sign and submit completed forms to: Banyan Administrators 0000 Xxxxx Xxxxx, Xxxxx 000 Mechanicsburg, PA 17055 Phone: (877) 480‐7923 Fax: (877) 237‐4519 Secure Email: xxxxxxxxxxxx@xxxxxxxxxxxx.xxx Secure portal: xxx.xxxxxxxxxxxx.xxx/xxxxxx‐portal/ * As used in this Subscription Agreement, Eligible Persons includes any W‐2 employee, proprietor, shareholders or partners of the firm.

Employee Participation Requirements.  Medical: at least 75% of Eligible Personseligible employees* must enroll. •  Dental and Vision: 100% of Eligible Personseligible employees* must enroll. •  Life and Long‐Term Disability: 100% of full‐time employees must enroll. Required Forms: •  Signatures cannot be dated more than 59 days prior to the requested effective date. •  Enrollment and Change Form must be completed by each full‐time employee when: o Enrolling in Medical, Dental, Vision, Group Life or Long‐Term Disability. o Waiving or terminating coverage for themselves and/or dependentsdependent. •  All former employees applying for COBRA/Cal‐COBRA coverage must complete the COBRA/Cal‐COBRA section of the Enrollment Form •  Beneficiary Designation Forms must be completed for Life and Long‐Term Disability. • Evidence of Insurability Information is required  Health Statements must be completed for groups of 2‐3 employees applying for Life and/or LTD or Long‐Term Disability coverage. •  All groups must submit a copy of their most recent DE‐9 and DE‐9c. •  HSA Administration form must be completed for groups electing integrated HSA administration. Missing signatures and questions left unanswered can delay the processing of your application. If you have any questions regarding or need assistance with reviewing the Subscription Agreement, please call Banyan Administrators – Managers for the CalCPA Health Programs at 877‐480‐7923. Once all questions have been answered, please sign and submit completed forms to: Banyan Administrators 0000 Xxxxx Xxxxx, Xxxxx 000 MechanicsburgXxxxxxxxxxxxx, PA 17055 XX 00000 Phone: (877) 480‐7923 Fax: (877) 237‐4519 Secure Email: xxxxxxxxxxxx@xxxxxxxxxxxx.xxx Secure portal: xxx.xxxxxxxxxxxx.xxx/xxxxxx‐portal/ * As used Note: this document was written to summarize the main requirements for new group applications and additional information may be required. A complete list may be found in this Subscription Agreement, Eligible Persons includes any W‐2 employee, proprietor, shareholders or partners of the firmUnderwriting Guidelines.

Employee Participation Requirements.  Medical: at least 75% of Eligible Personseligible employees* must enroll. •  Dental and Vision: 100% of Eligible Personseligible employees* must enroll. •  Life and Long‐Term Long Term Disability: 100% of full‐time employees must enroll. Required Forms: •  Signatures cannot be dated more than 59 days prior to the requested effective date. •  Enrollment and Change Form must be completed by each full‐time employee when: o Enrolling in Medical, Dental, Vision, Group Life or Long‐Term Long Term Disability. o Waiving or terminating coverage for themselves and/or dependentsdependent. •  All former employees applying for COBRA/Cal‐COBRA coverage must complete the COBRA/Cal‐COBRA section of the Enrollment Form •  Beneficiary Designation Forms must be completed for Life and Long‐Term Long Term Disability. • Evidence of Insurability Information is required  Health Statements must be completed for groups of 2‐3 employees applying for Life and/or LTD or Long Term Disability coverage. •  All groups must submit a copy of their most recent DE‐9 and DE‐9c. •  HSA Administration form must be completed for groups electing integrated HSA administration. Missing signatures and questions left unanswered can delay the processing of your application. If you have any questions regarding or need assistance with reviewing the Subscription Agreement, please call Banyan Administrators – Managers for the CalCPA Health Programs at 877‐480‐7923. Once all questions have been answered, please sign and submit completed forms to: Banyan Administrators 0000 Xxxxx Xxxxx, Xxxxx 000 MechanicsburgXxxxxxxxxxxxx, PA 17055 XX 00000 Phone: (877) 480‐7923 Fax: (877) 237‐4519 Secure Email: xxxxxxxxxxxx@xxxxxxxxxxxx.xxx Secure portal: xxx.xxxxxxxxxxxx.xxx/xxxxxx‐portal/ * As used Note: this document was written to summarize the main requirements for new group applications and additional information may be required. A complete list may be found in this Subscription Agreement, Eligible Persons includes any W‐2 employee, proprietor, shareholders or partners of the firmUnderwriting Guidelines.

Employee Participation Requirements. Medical: at least 75% of Eligible Personseligible employees* must enroll. • Dental and Vision: 100% of Eligible Personseligible employees* must enroll. • Life and Long‐Term Disability: 100% of full‐time employees must enroll. Required Forms: • Signatures cannot be dated more than 59 days prior to the requested effective date. • Enrollment and Change Form must be completed by each full‐time employee when: o Enrolling in Medical, Dental, Vision, Group Life or Long‐Term Disability. o Waiving or terminating coverage for themselves and/or dependentsdependent. • All former employees applying for COBRA/Cal‐COBRA coverage must complete the COBRA/Cal‐COBRA section of the Enrollment Form • Beneficiary Designation Forms must be completed for Life and Long‐Term Disability. • Evidence of Insurability Information is required Health Statements must be completed for groups of 2‐3 employees applying for Life and/or LTD or Long‐Term Disability coverage. • All groups must submit a copy of their most recent DE‐9 and DE‐9c. • HSA Administration form must be completed for groups electing integrated HSA administration. Missing signatures and questions left unanswered can delay the processing of your application. If you have any questions regarding or need assistance with reviewing the Subscription Agreement, please call Banyan Administrators – Managers for the CalCPA Health Programs at 877‐480‐7923. Once all questions have been answered, please sign and submit completed forms to: Banyan Administrators 0000 Xxxxx Xxxxx, Xxxxx 000 MechanicsburgXxxxxxxxxxxxx, PA 17055 XX 00000 Phone: (877) 480‐7923 Fax: (877) 237‐4519 Secure Email: xxxxxxxxxxxx@xxxxxxxxxxxx.xxx Secure portal: xxx.xxxxxxxxxxxx.xxx/xxxxxx‐portal/ * As used Note: this document was written to summarize the main requirements for new group applications and additional information may be required. A complete list may be found in this Subscription Agreement, Eligible Persons includes any W‐2 employee, proprietor, shareholders or partners of the firmUnderwriting Guidelines.

Employee Participation Requirements. Medical: at least 75% of Eligible Persons* must enroll. • Dental and Vision: 100% of Eligible Persons* must enroll. • Life and Long‐Term Disability: 100% of full‐time employees must enroll. Required Forms: • Signatures cannot be dated more than 59 days prior to the requested effective date. • Enrollment and Change Form must be completed by each full‐time employee when: o Enrolling in Medical, Dental, Vision, Group Life or Long‐Term Disability. o Waiving or terminating coverage for themselves and/or dependentsdependent. • All former employees applying for COBRA/Cal‐COBRA coverage must complete the COBRA/Cal‐COBRA section of the Enrollment Form • Beneficiary Designation Forms must be completed for Life and Long‐Term Disability. • Evidence of Insurability Information is required for groups of 2‐3 employees applying for Life and/or LTD coverage. • All groups must submit a copy of their most recent DE‐9 and DE‐9c. • HSA Administration form must be completed for groups electing integrated HSA administration. Missing signatures and questions left unanswered can delay the processing of your application. If you have any questions regarding or need assistance with reviewing the Subscription Agreement, please call Banyan Administrators – Managers for the CalCPA Health Programs at 877‐480‐7923. Once all questions have been answered, please sign and submit completed forms to: Banyan Administrators 0000 Xxxxx Xxxxx, Xxxxx 000 Mechanicsburg, PA 17055 Phone: (877) 480‐7923 Fax: (877) 237‐4519 Secure Email: xxxxxxxxxxxx@xxxxxxxxxxxx.xxx Secure portal: xxx.xxxxxxxxxxxx.xxx/xxxxxx‐portal/ * As used in this Subscription Agreement, Eligible Persons includes any W‐2 employee, proprietor, shareholders or partners of the firm.