Small Group Underwriting Policy Updates
Participation and Contribution Requirements
We will continue to waive participation requirements through the 2nd quarter 2014 for Off-Exchange business. This policy will be reviewed quarterly. The published underwriting guidelines will continue to reflect the participation requirements until any permanent decisions are made. All contribution requirements have been suspended at this time based on Affordable Care Act (ACA) requirements.
The Annual Group Information Form (AGIF) will remain a requirement for all benefit changes. However, we are currently evaluating this process and implementing changes to improve our efficiency.
Process for Groups No Longer Eligible for Commercial Group Coverage
We are continuing our review throughout 2014 and will be identifying groups that no longer qualify for medical group coverage. Groups that have already renewed from January 1, 2014 to May 1, 2014 will not be moved until their next renewal period in 2015. The exception is for May groups identified through a benefit change request. These groups will be provided with a 30-day notice and required to move to a direct pay option.
Beginning with June 1, 2014 renewals, groups identified as no longer eligible for medical group coverage will be provided with a minimum 30-day notice and required to move to the individual market. All identified groups should replace coverage with one of our direct pay options. We will not be automatically mapping any identified group into a direct pay product offering through this process. Our sole proprietor business will continue to be mapped through our product discontinuance to a direct pay offering.
Most of our CTA plans have a January 1, 2015 renewal period and the majority of the member firms and professional society members that no longer qualify for commercial group medical coverage will not be renewed at that time. We are preparing a communication specific to our CTA business which we will be sharing in the near future.
Please contact your dedicated Account Consultant if you have any questions.
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