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Enrollment Kit - Oscar (Medical)

This checklist is provided as a guide. The carrier may require additional items and documentation. Please refer to the carrier's underwriting guidelines for a complete list of requirements. Please use the latest version of forms.
 
Our goal is to process your new group enrollment easily and efficiently in order to provide you and your client with a quick approval.  The following list outlines Oscar’s case submission requirements.
 
  • Employer application (online or on paper)
  • Applications or waivers for all employees, including existing COBRA/Cal-COBRA enrollees
  • Group / owner eligibility documentation (any one of the following):
    • Current/active business license
    • Fictitious Business Name statement
    • Statement of Information
    • Articles of Incorporation
  • The most recent DE-9C or 4 weeks of payroll
  • Tax documents (see below)
In order to verify eligibility, Oscar's underwriting team may request additional documentation above and beyond what is listed.

Keep in mind that the group's coverage will not begin until the application has been approved by Oscar's Eligibility Team and payment has been received. Oscar may request additional documentation, including payroll records and employee wage and tax filings, to determine a group's eligibility. Check payments may take up to 10 days to process.

PLEASE NOTE: Any eligible employee or dependent enrolled in Oscar small group health coverage may not also be enrolled under an individual policy. The applicant must elect one or the other to avoid duplication of coverage.


Additional Required Enrollment Documents by Group Type
  • Sole Proprietorship
    • One of the following:
      • IRS Schedule C and 1040 Form (if owner is not listed on DE-9C)
      • IRS Schedule C and 1040 Form
      • IRS Schedule F and 1040 Form for Farms
      • NOTE: One life sole proprietors are not eligible. There must be one common law employee who is neither an owner, nor the owner's spouse or domestic partner.

  • Corporation
    • California Secretary of State active web confirmation, and one of the following:
      • Owner Affidavit
      • If owner is not listed on DE-9C, IRS Schedule K-1 (Form 1120-S) - include all K-1's totaling 100% ownership, IRS Form 1120 (pages 1-2), IRS Forms 1125-E or IRS Schedule G or a W-2
      • Additional proof of income for owner may be required if tax filings are not available due to length of time in business
      • NOTE: Corporations established out of state will also need to provide a Certificate of Qualification or Statement by Foreign Corporation in addition to the above documentation.

  • Partnership / Limited Liability Partnership (LLP)
    • If owner is not listed on DE-9C, recent IRS Schedule K-1 (Form 1065) - include all K-1's totaling 100% ownership, or Partnership Agreement & Tax ID Appointment Letter or W-2
    • NOTE: Corporations established out of state will also need to provide a Certificate of Qualification or Statement by Foreign Corporation in addition to the above documentation.

  • Limited Liability Company (LLC)
    • Statement of Organization with Operating Agreement
    • If owner is not listed on DE-9C, recent K-1 or other applicable tax filing document or W-2

  • Non-Profit Company
    • Most recent Quarterly Federal Tax Return (IRS Form 941), current payroll report, and one of the following:
      • IRS letter 501c3
      • IRS application for exempt status
      • California Secretary of State active web confirmation
      • National Federal Credit Union active web confirmation

  • Group who filed a consolidated tax return as an affiliated group
    • IRS Form 851, or a letter from a CPA

  • Churches
    • IRS Form 941
    • Payroll records form the prior 4 weeks

  • Seasonal industries
    • Prior four DE-9C reports

  • Spinoffs
    • 4 weeks of payroll or DE-9C, and relevant employer documentation listed above depending on type of group

Additional Tax Documents for Special Case Enrollees
  • New Hires not appearing on the most recent DE-9C
    • IRS Form W-2, and most recent two-week payroll report and dates of hire for all New Hire employees

  • COBRA / Cal-COBRA Coverage Enrollees
    • Most recent DE-9C Form on which employees appeared, or bill from group's prior carrier listing COBRA/Cal-COBRA enrollees

Licensing:  Broker appointment must be completed online via this link.  NOTE: The group will not be approved until licensing is received.

After approval, prior carrier termination letter must be submitted by the employer or broker.​

For other useful or older documents, please refer to the Forms database.