Revised Underwriting Guidelines Effective January 1, 2013
This is to inform you of revised underwriting guidelines effective January 1, 2013. The most recent guidelines are available on the Enroll Your Group page.
Revisions to the underwriting guidelines (PDF) include the following:
- For community-rated groups, an employer may not fund more than 50 percent to the in-network deductible amount for each tier. This is the maximum amount that can be funded toward any cost-share. For example, if the single tier deductible is $1,800 with 20 percent coinsurance, the employer can fund up to a maximum of $900 toward the single deductible. In addition, a health savings account or health reimbursement arrangement can only be attached to a high-deductible health plan product.
- Any changes off the renewal cycle will require prior approval. For community-rated business, no changes will be approved for effective dates within the three months prior to or after the group’s renewal date. Downgrade in benefits must result in at least a 5 percent rate differential in order to be considered. This also applies to groups moving off discontinued products, as well as to groups currently under a Chamber, Trust or Association moving to direct group. Please refer to the document titled "Off Cycle Change Exception" (PDF) for additional conditions that apply.
The Annual Group Information Form is required for all groups, unless the group is exempt. Your Account Consultant can provide a list of your groups that have not yet completed the form. We encourage you to reach out to these groups to obtain the completed form as soon as possible. If the Annual Group Information Form is not on file, we may not be able to release the renewal and/or process any renewal changes.
All new business will continue to be underwritten, and required forms must be submitted. To ensure the timely issuance of identification cards, paperwork should be received 30 days in advance of the effective date.
Required new business forms include:
- New Business Group Information Form (community-rated and experience-rated groups)
- Small Group Enrollment Checklist (community-rated groups)
- Underwriting Packet (community-rated groups)
These forms can be accessed on the Enroll Your Group page.
For additional information, please contact your Account Consultant.