Employer Health Program (EHP) Registration Step 1 of 3 - Employer Information 0% Section 1: Employer InformationEmployer Name(Required) Employer Association(Required) Expected EHP Start State(Required) MM slash DD slash YYYY Date when you expect to begin coverage for your employees Section 2: Employee InformationTotal Number of full-time, non-bargaining unit employees:(Required)How many employees are you enrolling in the EHP?(Required)Please note: The EAS Health Fund requires proof of other existing coverage for any full-time, non-bargaining employees not enrolled in the EHP. Section 3: Employer CertificationEmployer Certification(Required) I certify and acknowledge all of the following:1. Employer is a member in good standing of an association that is a sponsor of the EAS Carpenters Health Fund. 2. Employer has assigned its bargaining rights to such association. 3. Employer has a history of contributions to the EAS Carpenters Health Fund on behalf of bargaining unit employees. 4. Employer is current on fringe benefit contributions for bargaining unit employees. 5. Employer agrees to remit fringe benefit contributions for bargaining unit employees and EHP premiums for enrollees via iRemit. 6. Employer has enrolled all full-time non-bargaining unit employees, unless an employee has waived coverage; for any employee waiving coverage, Employer has received and attached proof of other coverage. 7. Employer agrees to provide EAS Carpenters Health Fund with Forms W-3 for all full-time, non-bargaining unit employees. 8. Employer agrees that EAS Carpenters Health Fund may perform a payroll audit to confirm enrollment of all full-time, non-bargaining unit employees every (3) years; or if the EAS Carpenters Health Fund is performing a compliance audit of Employer's fringe benefit contributions, Employer agrees to submit to a complete audit of EHP enrollment. 9. Employer agrees that failure to enroll all full-time, non-bargaining unit employees who have not otherwise properly waived coverage may result in expulsion from the EHP and prospective loss of coverage for enrollees. 10. Employer agrees that failure to enroll all full-time, non-bargaining unit employees who have not otherwise properly waived coverage may result in the imposition an Employer penalty, including payment of premiums for those otherwise eligible employees not enrolled, or, in egregious cases, the cost of claims paid on behalf of Employer's enrollees (including dependents). 11. Employer agrees that is Employer loses eligibility for participation in the EHP, enrollees will not be entitled to COBRA coverage. 12. Employer acknowledges that the EHP is subject to a Plan-wide maximum number of enrollees, which maximum may change on an annual basis. The EAS Carpenters Health Fund reserves the right to deny Employer participation for any plan year, even if Employer previously participated in the EHP. 13. The Trustees reserve the right to set and change the monthly premium charged for coverage. As of July 1, 2023, the monthly EHP premium is $1,484.81 per employee. 14. Total EHP premiums are due monthly between the 25th day of the month and the last day of the month for coverage in the next month. If premiums are not received by the 5th day of the coverage month, coverage will be terminated. Full Name(Required) Title(Required) Email(Required) Enter Email Confirm Email Signature(Required)
