BenefitMall Submission Process (2-50)

This document outlines the eligibility requirements, submission requirements, and submission process for BenefitMall’s Level Self-Funded (LSF) and Fully Insured options. Each submission requires census information and additional documentation based on the type of plan.

For group submissions 51-100:

Benefit Mall Submissions 51-100

For group submissions over 100:

Benefit Mall Submissions Large groups (100+)

1. Eligibility Requirements

General Census Information Required for All Submissions

• Group Information:
  • SIC Code / Nature of Business
  • Effective Date
  • First Name, Last Name, Date of Birth (DOB), Gender, Zip Code, Employee/Spouse/Child (E/S/C) classification
• Additional Information that may be required:
  • Number of Eligible and Enrolled Employees
  • Full-Time Equivalent Count
  • Current Rates and Benefits
  • Renewal Rates and Benefits
  • DOL4 tax form
  • TAX ID
  • IMQ’s

2. Submission Requirements

Additional LSF Requirements

• If LSF under 10 lives: Provide IMQs (not ACA).
• If LSF: Tax ID must be provided.

Level Self-Funded (LSF) Requirements by Carrier

UHC - United Health Care (2-300 Enrolled)

• 2 to 4 enrolled → Individual Medical Questionnaires (IMQs) required.