Applications and Forms for Employers
Find the forms, guides and deadline documents your business needs to enroll in Covered California for Small Business and manage your plan.
Enrollment How-to Guides
The resources below are designed to help your small business manage its responsibilities as a plan sponsor.
Step-by-step instructions are included with each resource, but feel free to contact us if you need more help.
Enrollment Applications
Download the employer application in English or Spanish.
Need help with employer forms?
Our team can help you identify the right form, understand submission requirements and get your enrollment on track. Reach out Monday through Friday, 8 a.m. to 5 p.m.
Submission Deadlines
CCSB will accept new business submissions through the first five business days of the month for that same month’s insurance, provided the New Business Late Submission Acknowledgement (PDF) is signed and submitted with the enrollment application. If the group does not agree to the submission acknowledgement, the effective date will be the first of the month following the requested effective date.
Employer Change Requests
Use the Employer Change Form to make changes to your group’s reference plan, coverage levels and contribution levels, or to change the address or ownership of your small business.
Employer Support and References
How to Submit Your Forms
Send completed employer forms to the Covered California for Small Business service team by email or mail:
Email: ccsbeligibility@covered.ca.gov
Mail: Covered California for Small Business, P.O. Box 7010, Newport Beach, CA 92658
For questions about which form to use or how to submit it, contact our team.