Impacts of the Expansion of Community Rating
Before open enrollment begins, we want to provide you with some information specific to groups who may be impacted by the expansion of community rating to groups with 100 or fewer full time equivalent employees.
Process to confirm impacted groups
Each of you will soon be provided a list of the employer groups under your respective broker of records that we believe will need to change their funding arrangements as a result of the mandate. Your account manager will provide a list of the groups as well as a copy of the new Annual Group Information Form (AGIF). We are asking that you complete the AGIF for each group by the end of August so that we can ensure that the group moves into the appropriate arrangement. The completed AGIF can be sent directly back to your account manager and they will initiate the process for review and confirmation with underwriting. Our goal is to turn each around in two weeks.
Early renewals for groups impacted by the mandate
For groups impacted by the mandate, we are making slight modifications to our mid-year benefit change policies:
1) Groups that are currently experience rated, have 51 - 100 full time equivalent employees and are scheduled to renew on or after January 1, 2016 will be allowed to request a 12 month contract for an experience rated plan running from December 1, 2015 through November 30, 2016. All member benefit accumulators would reset on December 1, 2015 as result of this change.
2) Groups that are currently experience rated, have 51 - 100 full time equivalent employees and are scheduled to renew after January 2016 will be allowed to move to a community rated product effective January 1, 2016 regardless of their currently scheduled renewal date. All member benefit accumulators would reset on January 1, 2016 as result of this change and full underwriting paperwork will be required.
3) Groups that are currently community rated, have 100 or fewer full time equivalent employees and are scheduled to renew in January 2016 will NOT be allowed to renew in a community rated plan ahead of their scheduled renewal. This affirms our current policy of not allowing mid-year benefit changes. Exceptions will be allowed for groups that are currently community rated but who have more than 100 full time equivalent employees, and therefore must move to an experience rated program upon renewal in 2016. These groups will be allowed to renew in a community rated product effective December 1, 2015 with full underwriting.
Groups not impacted by the expansion of community rated
Please note that the above policies only apply to groups impacted by the expansion of community rating. Our current policy – that mid-year benefit changes are not permitted – remains in place.
If you have any questions, please contact your account consultant.