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Participation and Alongside Guidelines

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Aetna

Standalone

1-4 enrolled employees: 60% participation rounded down

5+ enrolled employees: 25% participation

Alongside Another Carrier

1-4 California enrolled employees: 60% participation

5+ California enrolled employees: 25% participation and a minimum of 5 enrolling in California

 

Anthem BlueCross

Standalone

1-4 enrolled employees: 65% participation through Quarter 2 2021 effective dates

5+ enrolled employees: 25% participation through Quarter 2 2021 effective dates

Alongside Another Carrier

Employees covered by the same employer on another group policy are not considered a valid waiver

Another carrier’s HMO or PPO plans can be sold alongside Anthem as long as Anthem receives the required participation

 

Blue Shield of California

Standalone

70% participation for mirror plans

65% participation for off exchange plans

25% participation for off exchange plans available to groups of 5+ enrolling through December 31, 2021

0% participation for groups selecting Trio HMO only or Tandem PPO only plans with no end date

Applies to Specialty Products

Alongside Another Carrier

Only one major medical carrier is allowed to be written alongside Blue Shield. Health exchanges are not eligible. MediExcel or SIMNSA can be written alongside as a third carrier

The Mirror Package for Small Business cannot be offered alongside another carrier. At least 25% of the total number of eligible employees must enroll with no fewer than 5 enrolled. Blue Shield must be the sole
carrier for dental, vision and life plans

Employees covered by the same employer on another group policy are ot considered a valid waiver

 

CaliforniaChoice

Standalone

1-2 eligible employees:100% participation

3+ eligible employees: 70% participation

Alongside Another Carrier

Cannot be written alongside another carrier

 

Health Net

Enhanced Choice A and Enhanced Choice B package: 70% with 1-5 eligible, 25% for 6+ eligible with a minimum of 5 enrolling
 
Promotion will end 3/31/2021:
No participation requirement for Salud Package with minimum of 2 enrolled. Waivers are not required for Salud Package
 
Promotion through 6/15/2021:
HMO Package: No participation or Participation Attestation Form required with 6+ active enrolling employees

Waivers are not required

Mix and Match any plans from the HMO networks for HMO Package promotion

HSP, EnhancedCare PPO and Full Network PPO plans do not qualify for the HMO Package promotion

Alongside Another Carrier

Another carrier’s HMO or PPO plans can be sold alongside Health Net as long as Health Net receives the required participation

Employees covered by the same employer on another group policy will not be considered a valid waiver on the Enhanced Choice A & Enhanced Choice B plans

 

Kaiser Permanente

Standalone

50% of eligible employees must be covered by a group plan

Alongside Another Carrier

A minimum of 1 must enroll with Kaiser Permanente

 

UnitedHealthcare

Standalone

60% participation for all group sizes excluding valid waivers

Uniform child enrollment is required. All enrolling children’s Product Selection must match for each line of coverage

Employees who are waiving due to enrolling as dependents under another employee at the same group are not considered valid waivers

Alongside Another Carrier

Choice Simplified Package alongside to staff model carrier: 60% participation between the carriers with 5 CA employees enrolling with UHC is required

Multi-Choice® State Package alongside to staff model carrier: 60% participation with UHC is required

Eligible staff-models include: CCHP, KP, MediExcel, Sharp, SIMNSA, Sutter and WHA

Participation and Alongside Guidelines

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


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