Life and Health - Forms

Employer
PA
Texas State Continuation Form
COBRA Form
IRS Form 1095-c
American Public Life
Blue Cross and Blue Shield
Reliance Standard

Who needs to file an IRS Form 1095-c?

The health care law defines which employers must offer health insurance to their workers. The law refers to them as an “applicable large employers,”.

A company or organization is an applicable large employer if it has at least 50 full-time workers or full-time equivalents.

A full-time worker, according to the law, is someone who works at least 30 hours a week.

A full-time equivalent, meanwhile, is two or more part-time employees whose hours add up to a full-time load. Two workers who each put in 15 hours a week, for example, would make up one full-time equivalent (15 x 2 = 30 = 1 Full-time equivalent). 

Only applicable large group company or organization are required to file Form 1095-C.

IRS Form 1095-c
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COBRA (consolidated omnibus budget reconciliation act (cobra) of 1985) 
COBRA is a federal law which requires employers and organizations with 20 or more employees who offer health insurance benefits the option of continuing their coverage due to termination of employment, reduction in hours or other qualifying events.

Who needs send COBRA notification letters?

Employers and organizations with 20 or more employees for more than 50% of the previous calendar year are subject to COBRA. Employers  and organizations with fewer than 20 employees may be subject to State Continuation depending on the employers state of domicile.

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Texas State Continuation Form 
State Continuation is a state law which requires employers and organizations with 2 to 19 employees who offer health insurance benefits the option of continuing their coverage due to termination of employment, reduction in hours or other qualifying events.

Who needs send State Continuation notification letters?

Employers and organizations with 2 to 19 employees for more than 50% of the previous calendar year are subject to State Continuation. 

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Reliance Standard Insurance Company
Dental, Life,  Vision, Long-term and Short-term Disability insurance for groups of 2 to 19 employees

Reliance Standard can enroll your group with a simple master application which includes a census. New hires being added to the plan must complete an individual employee application. This system will allow you to print the with pre-filled information. To print an individual employee application, select from the list below.

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Blue Cross and Blue Shield
Group Health, Dental, Life,  Vision, Short-term Disability insurance for groups of 2 to 50 employees

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American Public Life (APL)
Gap insurance. Coverage for deductibles and out-of-pocket expenses. 

Employer and and employee applications

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