CalCPA Health Enrollment
- 2017 Group Enrollment Form (Subscription Agreement)– Employer Application for all size firms – Your firm need only complete one subscription agreement regardless of how many group plans you elect.
- Employee Medical/Dental/Vision Enrollment form (For firms of 2 or more. All employees must complete the form. Employees waiving coverage must complete the waiver section.)
- 2017 Dental – Vision Enrollment Form (If enrolling in Dental and/or Vision only).
- 2017 Subscriber Change Form
- Medicare Secondary Payer (MSP) Statement (Applicable to firms with fewer than 20 employees)
- Group Life-LTD Health Statement (For firms enrolling 3 or fewer persons in the Group Life or Group LTD program.)
- Group Term Life-LTD Enrollment Form (for groups of 2-9 only)
- 2017 Summary of Benefits and Coverage (SBCs)
Groups of 1-50 employees can enroll online through the CalCPA Health enrollment area. This area offers group medical, dental, and vision plans, all available in one convenient enrollment process. Here you can get quotes on all the plans and choose the ones that best fit the needs of your firm. Once your firm submits its eligibility information and is approved to enroll, you can, at your discretion, allow your employees online access to enroll themselves and their family members.
(Please note you will be leaving the CalCPAHealth.com website.)
If you are a solo practitioner, you are eligible to enroll in the CalCPA Health Vision and Dental plans, and you may apply for Individual Term Life and Individual Disability policies.
If you would like to enroll in Medical coverage, contact Banyan Administrators, Managers for the CalCPA Health Programs, at 877.480.7923 or email at CalCPAHealth@key.insurance. They can assist you in choosing and applying for an Individual plan through Anthem Blue Cross. Banyan would continue to be your point of contact for customer service inquiries.