Untitled Document
Tax Documentation
 

Qualification Requirements And Tax Documentation

Want to learn more about Tax Documentation and Qualification Requirements? Here are some links to get you started:
   
  Qualification Requirements
   
  Group and Self-Employed Medical Insurance Effective and Deadline Dates
   
  Tax Documentation for Groups
   
  Percentage Requirements
   


Qualification Requirements
Group Medical Insurance Qualifications
  Self-Employed Medical Insurance Qualifications
You must have at least 2 Full-Time Employees on the Payroll working a minimum of 20hours for at least state required minimum wage.  
You must be the only ONE on the payroll.

You must have your corporation papers listed below available.  
You must have your corporation papers listed below available.
Most Group cases must be submitted 15 days prior to the requested effective date for efficient processing time.  
Most Self-Employed cases must be submitted 15 days prior to the requested effective date for efficient processing time.

 

Group and Self-Employed Medical Insurance Effective and Deadline Dates

Company State Effective Date DeadlineDate
Aetna NY NY 1st and 15th 15 days prior
Atlantis Health Plans NY only 1st and 15th 15 days prior
Atlantis Health Plans - Self Employed NY only 1st ONLY 15 days prior
Capdent & Capdent PLUS NY 1st ONLY 15 days prior
Cigna Health Care - NY NY only 1st ONLY 15 days prior
Cigna Health Care - NJ NJ only 1st and 15th 15 days prior
Empire Blue Cross NY 1st and 15th 15 days prior
GHI NY only Any Date 8 days prior
GHI - Self Employed NY only Any Date 15 days prior
Guardian Dental NY 1st and 15th 15 days prior
Guardian HealthNet NY 1st and 15th 15 days prior
HIP Health Plans of NY NY only 1st and 15th 15 days prior
HIP Health Plans of NY - Self Employed NY only 1st ONLY 15 days prior
Horizon HealthCare NY only 1st and 15th 15 days prior
LIA Health Alliance NY only 1st ONLY 15 days prior
Oxford Health Plans NY & NJ 1st and 15th 8 days prior
Vytra Health Plans of Long Island NY only 1st and 15th 15 days prior
WellChoice NJ only 1st and 15th 15 days prior

Tax Documentation

For Groups of 2-50+ (on the payroll)

NYS-45 - Quarterly Combined Withholding, Wage Reporting and Unemployment Insurance Return including Attachment ( 2 pages - must list all employees employed ). ( New York )
WR-30 - Quarterly Combined Withholding, Wage Reporting and Unemployment Insurance Return including Attachment ( 2 pages - must list all employees employed ). ( New Jersey )
UC2-5A - Quarterly Combined Withholding, Wage Reporting and Unemployment Insurance Return including Attachment ( 2 pages - must list all employees employed ). ( Connecticut )
• W4 - Employee’s Withholding Allowance Certificate - for New Hires
who do not appear on the NYS-45 yet.
For a Limited Liability Partnership or Limited Liability Corporation
1065 - U.S. Return of Partnership Income.
Schedule ‘K-1′ - Partner’s Share of Income, Credits, Deductions, etc. ( Most medical insurance companies require all Schedule K-1’s to equal 100% Partnership - even if all partners are not accepting the medical coverage offered by the group ).
Schedule ‘E’ - Supplemental Income and Loss From Rental, Real Estate, Royalties, Partnerships, S. Corporations, Estates, Trusts, REMIC’s, Etc.
Partnership Agreement - For New Partnership.
For a New Corporation / Incorporation
Articles of Incorporation / Organization - New Corporation, Existing Corporation or LLC.
W4 - Employee’s Withholding Allowance Certificate - For all employees accepting medical coverage.
Paystubs / Payroll Run from Paychex ( or equivalent ) - For all employees.
For an S. Corporation
1120S - S. Corporation
CT-6 - Election by a Federal S. Corporation to be Treated as a New York S. Corporation.
NYS-45 - Quarterly Combined Withholding, Wage Reporting and Unemployment Insurance Return including Attachment ( 2 pages ).
Schedule ‘E’ - Supplemental Income and Loss From Rental, Real Estate, Royalties, Partnerships, S. Corporations, Estates, Trusts, REMIC’s, Etc.
W4 - Employee’s Withholding Allowance Certificate - for New Hireswho do not appear on the NYS-45 yet.
Self-Employed / Sole Proprietor ( Only One Employee )
Schedule ‘C’ - Profit and Loss From Business ( of the 1040 Individual Income Tax Return ).
1040 - Individual Income Tax Return.
Schedule ‘SE’ - Self-Employed Tax.
If the Business is new as there is no Tax documentation set up yet *
Your Business Name.
Employer Identification Number (EIN).
Partner Names.
Partner Social Security Numbers.
Percentage Amount for Each Partner.
Employees Names.
Employees Social Security Numbers.
Expected Tax Documentation the Business will file going forward.
SS-4 - Application for Employer Identification Number ( EIN )
Articles of Incorporation / Organization - New Corporation, Existing Corporation or LLC.
Business Certificate - This form must be Notarized by the County your business is located in.
CPA letter – The letter MUST be on CPA or Attorney Company Letterhead, MUST contain the following and be accompanied by W4’s for all:
Your Business Name.
Employer Identification Number (EIN).
Partner Names.
Partner Social Security Numbers.
Percentage Amount for Each Partner.
Employees Names.
Employees Social Security Numbers.
Expected Tax Documentation the Business will file going forward.
   
* Tax Documentation is required by each of the medical insurance carriers with the submission of group cases within New York State. The major medical carriers might deny your group submission if they do not receive proper state documentation to reinforce that your company is a valid candidate for group insurance. For state other than New York,
please speak to your group insurance salesperson.

Percentage Requirements

NY - Minimum Percentage of Enrollees on NYS-45
Company Product Percentage Requirement
Aetna HMO - POS – PPO No Requirement
Aetna MC 60%
Aetna Dental Minimum 10 Employees
Atlantis Health Plans HMO – POS No Requirement
Capdent Dental for Individuals Dental HMO No Requirement
Capdent Dental for Groups Dental HMO Minimum 3 Employees
Capdent PLUS for groups Dental HMO Minimum 3 Employees
Cigna HealthCare HMO - POS – PPO No Requirement
Cigna HealthCare Dental Dental Minimum 10 Employees
Empire Blue Cross BlueShield HMO No Requirement
Empire Blue Cross BlueShield POS – PPO 60%
Empire Blue Cross Blue Shield DMO Minimum 2 Employees
Empire Blue Cross Blue Shield PPO Minimum 5 employees
GHI Group Health Incorporated HMO No Requirement
GHI Group Health Incorporated POS 50%
Guardian Dental
PPO 75% - Purchase with or without medical
Guardian HealthNet HMO No Requirement
Guardian HealthNet POS – PPO 75%
HealthPlex Preferred Dental PPO Minimum 3 Employees
Horizon HealthCare PPO No Requirement
Horizon HealthCare PPO 50%
Horizon HealthCare Dental
PPO No Requirement - Purchase w/wo medical
HIP Health Plans of New York HMO – POS No Requirement
LIA Health Alliance
HMO - POS – PPO No Requirement (Except GHI PPO- 50%)
Met Life Dental Dental Will write under 10, but all 10 must participate
Oxford Health Plans POS No Requirement
Oxford Health Plans
Dental No Requirement - Must be purchased w/ medical
US Life Dental PPO Large group only - No small group or individual
Vytra Health Plans of Long Island HMO No Requirement
Vytra Health Plans of Long Island POS 75%

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Phone : (718) 674-2291 E-mail: info@gospichadvisors.com