SIMPLIFY HR - With our Online Benefits Enrollment, Administration and HR system. powered by Employee Navigator for clients of Beckham Insurance Group http://choosebeckham.com/employee-navigator/ We are pleased to present our clients with Human Resources, Benefits Administration, and Payroll. All in one place… Current clients will implement at renewal and new clients will implement at effective date. INSTRUCTIONS FOR PROPER IMPLEMENTATION. Please answer questions 1-7 below Answer Below 1. What is the waiting period for new hires? 2. What is the payroll frequency? 3. Does Premium Contribution vary by class? If so please explain class and contribution structure 4. Do you want to utilize our employee onboarding feature for automated new hire documents? 5. Do you want to utilize our COBRA integration feature? ($1.50 PEPM) 6. Input Y or N for Coverage the Employer would like to offer Employees. If Yes, then input Employer Contribution Amount or type "Voluntary" Line of Coverage Medical Dental Vision Short Term Disability Long Term Disability Group Life Voluntary Life Critical Illness / Cancer Accident GAP Plan Y or N Employer Contribution ( % or $) FYI - VOLUNTARY Participation Requirements* N/A Greater of 3 enrolled or 20% of group Greater of 3 enrolled or 20% of group 5 enrolled Greater of 10 enrolled or 25% of group How much Coverage? 1 x salary or flat $ Greater of 10 enrolled or 25% of group 5 enrolled 5 enrolled 5 enrolled *Participation requirements WAIVED if employer contributes minimum $15 PEPM toward any combination of supplemental benefits above. 7. Complete Census on next tab; green columns are required, yellow columns preferred. Census required to pre-load employees on software system prior to enrollment **Deadline for returning form is 28 days prior to effective date if changing medical plans and 14 days prior to effective date if no medical plan change. Company Name: Contact Name: Date: Employee SSN* Phone Number Last Name* Tobacco User First Name* On Wellness Middle Name Job Title Suffix Marital Status Date of Birth* Is Full Time Hire Date* Is Exempt Gender* Hourly Rate Class* (salary or hourly) Employee ID Payroll Group* (if multiple payrolls) Payroll ID Annual Base Salary* Original Hire Date Salary Effective Date Affiliate Hire Date Email Department Address 1 Division Address 2 Business Unit City Office State Cost Center Zip Code Demographic Change Date County Country
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