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Broker News | September 2015 | Vol. 10 No. 8
Broker News | September 2015 | Vol. 10 No. 8

Important Information for Groups That No Longer Qualify as Small Group

Some groups that are currently community rated because they are classified as small groups may no longer qualify for community rating in 2016.

Beginning in 2016, the Affordable Care Act requires companies to have common-law employees enrolled in the coverage in order to be eligible for group health insurance. Generally, a common-law employee is anyone who performs services for an employer, and receives wages, if the employer can control what will be done and how it will be done. A common-law employee does not include the sole owner of a business or a spouse of the business owner. 

We will be assisting groups that no longer qualify as small group in the following ways:

  • Notifications will be mailed to groups that no longer qualify for small group coverage within the next 30 days.
  • Brokers will be receiving a list of their impacted groups from their account consultant.
  • If a broker feels their group still qualifies for small group coverage they should contact their dedicated account manager to work with an underwriter on resolution.
  • If a group does nothing, the group’s members will be automatically enrolled in an individual market plan similar to the plan they are in now. If members wish to select an individual plan other than the one they were automatically enrolled in, they should call 1-888-576-6593.
  • Members who are Medicare eligible will not be automatically enrolled in a plan. For help selecting a plan, they can call 1-800-659-1986 or visit excellusmedicare.com.

 

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