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How to Apply

Step 1
Check Your Eligibility
Step 2
Get a Quote
Step 3
Finalize Your Enrollment

What documents and information do I need to apply?

  • Employer’s name, as reported to the California Employment Development Department.
  • Federal Employer Identification Number (FEIN) and State Employer Identification Number (SEIN).
  • A copy of the employer’s local business license.
  • A DE-9C reconciled by the employer.
  • The total number of full-time employees.
  • The total number of part-time employees working 20 to 29 hours per week (if offering part-time employees’ coverage).
  • Employee roster, including addresses, hire dates, dates of birth, and Social Security numbers or tax identification numbers.
  • Dependent information (if offering coverage), including dates of birth.

Other ways to apply

By Mail

Mail your completed application, including all employee applications and other required documents, to:
Covered California for Small Business
P.O. Box 7010
Newport Beach, CA 92658

By Email

With the Help of a Local Agent

Get free assistance from our certified local agents who are deeply knowledgeable about CCSB. As partners of Covered California, they offer expert guidance to make your enrollment process smooth and stress-free, ensuring you find the best coverage for your business needs.

Find an Agent