[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-301892-105":53,"doc-detail-301892-en":118},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":111,"head_meta":113,"extra_data":115,"updated_unix":117},105,"en","new-group-checklist-mediexcel-health-plan","New Group Checklist - MediExcel Health Plan","","This document serves as a comprehensive administrative checklist for organizations applying for the MediExcel Health Plan. It details the mandatory documentation required for group enrollment, including signed enrollment forms, cross-reference sheets, and initial premium deposits. The guidelines provide specific criteria for verifying employer ownership status across various business structures, such as sole proprietorships, partnerships, and corporations. Additionally, it outlines the specific requirements for small and large group reporting, including DE-9C reconciliation and employee rosters, while also specifying the necessary broker credentials such as licenses, W-9 forms, and E&O certificates. This structured approach ensures all essential paperwork is submitted accurately to facilitate a seamless enrollment process.",{"@graph":63,"@context":110},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/new-group-checklist-mediexcel-health-plan/301892/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/new-group-checklist-mediexcel-health-plan/301892.png","ImageObject",442,249,{"name":88,"@type":89},"Maeve","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-09-26","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":76},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104],{"name":105,"@type":106,"acceptedAnswer":107},"What broker paperwork is required for the application?","Question",{"text":108,"@type":109},"Brokers must submit a copy of their license, a completed W-9 form, an E&O insurance certificate, and a signed Broker Agreement.","Answer","https://schema.org",{"og:url":78,"og:type":112,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":114,"canonical":78},"index,follow",{"doc_id":116,"site_id":56},301892,1790359093,{"code":4,"msg":5,"data":119},{"doc_id":116,"user_id":120,"nickname":88,"user_avatar":121,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":122,"file_id":123,"file_url":124,"file_type":125,"file_size":126,"view_count":76,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":9,"language":127,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":128,"faqs":129,"seo_title":130,"seo_description":61,"update_tm":131,"read_time":4},5909877438554,"https://ap-avatar.wpscdn.com/avatar/5600025385ad2bf12a7?_k=1778553567797529272","New Group Checklist  \n􀂆 Group Application  \n􀂆 Signed enrollment application from each EE  \n􀂆 Declination of coverage form If MediExcel Health Plan is wrapping with a US carrier, a waiver is NOT required.  \n􀂆 Cross Reference Sheet for all enrolling members (Excel Format)  \n􀂆 Deposit check made out to MediExcel Health Plan for the first month’s premium .  \n􀂆 Employer Ownership paperwork (required if the names of the owners do not appear on the most recent DE-9C).  \nAcceptable forms of documentation include:  \nFor a Sole Proprietor  \no Business license,  \no Fictitious business name statement, or  \no Schedule C tax form  \nFor a Partnership/LLC  \no Business license (showing all names)  \no Fictitious business name statement (showing all names)  \no Schedule K tax form (for each partner)  \nFor a Corporation  \no Corporation documents  \no Articles of incorporation  \no Statement of information  \nIn addition to the items listed above we will also need:  \nFor Small Group:  \n􀂃 DE-9C-To reconcile the DE-9C, please indicate the appropriate code next to each employee’s  \nname.  \nT-Terminated (indicate term date)  \nE-Eligible and enrolling  \nW-Eligible and waiving for other group or individual coverage  \nI-Ineligible (part-time, seasonal, waiting period)  \nFor Large Group :  \n􀂃 Complete employee roster for each employee which includes: name, eligibility for benefitsand health plan selected  \n􀂆 Broker Paperwork  \n􀂃 Copy of License, W-9 and E&O certificate  \n􀂃 Broker Agreement","cbCaimagBtVhNSQN","https://ap.wps.com/l/cbCaimagBtVhNSQN","pdf",76400,"English","# Required Enrollment Documentation\n## Employer Ownership Verification\n## Employee Reporting Requirements\n## Broker Requirements","[{\"question\":\"What broker paperwork is required for the application?\",\"answer\":\"Brokers must submit a copy of their license, a completed W-9 form, an E\\u0026O insurance certificate, and a signed Broker Agreement.\"}]","New Group Checklist - MediExcel Health Plan | PDF",1789786199]