Received your quote and ready to apply? Online enrollment using MyCCSB is designed to help you apply for coverage and manage your company’s health and dental plans. Once you are registered and complete the application process, you can:
Still need a quote? For more information on how to get a quote, please see our Get a Quote page.
For new and existing CCSB customersRegister
To apply, employers will need:
- Their employer name, as reported to the California Employment Development Department.
- Their federal Employer Identification Number (FEIN) and state Employer Identification Number (SEIN).
- A copy of their local business license.
- A DE-9C reconciled by the employer.
- The total number of employees.
- 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).
- Their employee roster, including addresses, hire dates, dates of birth and Social Security numbers or tax identification numbers.
- Dependent information (if offering dependents coverage), including the dependents’ dates of birth to determine their age.
New CCSB customers can enroll online using the Employer Portal. Printable applications are also available below and include step-by-step instructions
- 2020 Employee Application (for effective dates Jan. 1 to March 1, 2020)
- 2019 Employee Application (for effective dates Jan. 1 to June 1, 2019)
- 2019 Employee Application (for effective dates June 1 to Sept. 30, 2019)
- 2019 Employee Application (for effective dates Oct. 1 to Dec. 1, 2019)
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
Fax: (949) 809-3264
Should you need assistance with your health plan application, please contact a member of the CCSB Sales team at firstname.lastname@example.org or by calling (844) 332-8384, Monday through Friday, between 8:00 a.m. and 6:00 p.m.
For Employer Portal technical assistance, call (877) 368-2840, Monday through Friday, between 8:00 a.m. and 6:00 p.m.