NEWSROOM

Aetna

Guideline:

Groups of 6+ enrolled with prior coverage

The most recent prior carrier bill is required

Any employees not on the bill must have their full names written in with the reason they do not appear on the bill
 

Anthem Blue Cross

Promotion:

Groups of 3+ enrolled through Quarter 2 2021 effective dates

Copy of last month’s prior carrier bill is required for all products selected

Payroll records are required for employees not listed on the prior carrier bill

Excludes virgin groups

New groups without prior coverage will need to submit DE9C or payroll records
 

Blue Shield of California

Guideline:

Groups of 3-95 FT/FTE that have 3-95 eligible employees do not require a DE9C. Owners do not qualify towards the eligible FT/FTE employee count

DE9C will be required for groups with employees 65+ years old enrolling regardless of group size

DE9C will be required for groups with 2+ enrolling employees residing at the same address regardless of group size

Underwriting reserves the right to request the wage and tax information (DE9C, payroll) whenever necessary to determine eligibility

If a group is enrolling with Out Of State employees, companywide payroll may be requested to confirm 51%
eligible are in California

No DE9C guideline does not apply to groups with eligible employees who are 65+ years old, PEO, Union/Non Union, Start-Up, Spin Off and Multiple Employer groups
 

CaliforniaChoice

Guideline:

Groups of 6+ medically enrolling employees

The most recent prior carrier bill is required

Employees that are enrolling and are not listed on the prior carrier bill will require one full run of payroll showing eligible hours and wages

Groups with a lapse of coverage of more than 3 months are not eligible

Health Net

Enhanced Choice A and Enhanced Choice B Package through 6/15/2021 effective dates

Quarterly Wage Report/DE9C not required for groups with 5+ enrolling

Waivers are required to determine participation

Virgin Groups are eligible

HMO Package through 6/15/2021 effective dates

Quarterly Wage Report/DE9C not required for groups of 6+ enrolled

Participation Attestation Form, Prior Carrier Bill and Waivers are not required

Virgin Groups are eligible

The HMO package is separate from the Enhanced Choice A and B packages

Mix and Match any plans from the HMO networks
HSP, EnhancedCare PPO, and Full Network PPO plans do not qualify for this promotion

Kaiser Permanente

Promotion:

Quarterly Wage Report/DE9C not required for 6 or more eligible with no end date

Business Documentation required (example: business license/SOI)

Start Up groups and groups leaving a PEO do not qualify for this promotion

UnitedHealthcare

Guideline:

Groups of 10+ eligible employees

Completed and Signed Participation Certification Form is required
 

This guide has been created as a quick reference and does not replace the full underwriting guidelines published by each carrier

Please refer to the carrier guidelines for additional information