Anthem Blue Cross Small
Group Underwriting Guidelines
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Participation
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EmployeeElect Portfolio:
The standard group
participation requirement in
the employer’s Blue Cross
California Small Group
Health Plan is a minimum
of 75% of the eligible
employees. BeneFits
Portfolio: A minimum of 60%
of the eligible employees
are required to enroll in
the employer’s Blue Cross
Small Group plan.
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Required Group Size
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2-50 |
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Employer Contribution
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Employers must contribute
either: Traditional Option –
A minimum of 50% of the
employee’s monthly health
premium or Fixed Dollar
Option – Any fixed dollar
amount $100 or greater (in
$5 increments) per employee
per month for employee’s
health premium or Percentage
& Plan Option – A minimum of
50% toward a specific plan,
chosen by the employer. It
is NOT available for the
Basic PPO Plan. |
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Kaiser Split Carrier
Participation
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75% of eligibles must enroll
with Blue Cross. Waivers
required for Kaiser
enrollees but will count as
eligibles towards
participation requirements.
As long as 75% participation
is met, group may choose any
or all EmployeeElect plans.
If selecting “EmployeeChoice”,
waivers for Kaiser enrollees
are considered valid waivers
& don’t count towards
participation requirements.
Minimum of 5 must enroll.
(Applies only to
EmployeeChoice program.) For
BeneFits program, 60%
participation required.
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Participation with
Carriers Other Than Kaiser
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Only allowed with
EmployeeChoice product.
Requires 75% participation
with minimum of 5 enrolled.
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Cal-COBRA/COBRA
Maximum |
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No maximum. 10% premium load
for CAL-COBRA employees.
Groups may charge a 2%
administration fee for
Federal COBRA. |
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Out of Area/State
Maximum |
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49% Maximum |
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Composite Rates
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Not Available for medical.
Composite Life program is
available. |
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NCQA |
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Excellent |
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Domestic Partners
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Affidavit or equivalent
document required for
opposite sex domestic
partners under 62 years of
age. |
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Administrative Fees
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No |
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Lowest Possible RAF
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Groups size 2-4 best rate is
1.0; groups size 5-50 may
qualify for the
lowest RAF of .90
subject to underwriting
approval. Qualifying groups
with Integrated MediComp
Workers' Compensation
coverage continue to be
eligible for medical
savings. |
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Carve-Outs
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Class carve-outs such as
management only, union vs.
non-union, or salary vs.
non-salary may be considered
with underwriting approval
(minimum eight enrolling
employees). |
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Product Combinations
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EmployeeElect Portfolio:
Employers have the option of
selecting "all plans" for
their employees, or
designating specific plan
options. (Note: Power
SelectHMO Plan cannot be
offered along with any other
HMO plan.)
BeneFits Portfolio:
Employers may offer a
package consisting of 5
plans (Hospital BeneFits,
Hospital BeneFits Plus,
Hospital BeneFits Preferred,
PPO $35 Copay GenRx and
Power SelectHMO).
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1099 Contractors
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No |
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Waiting Periods
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The employer has the option
of choosing a
first-of-the-month following
hire date or 1-, 2-, 3-, 4-,
5- or 6-month waiting period
for all future employees.
The eligibility date for
coverage for future
employees is always the
first day of the month
following completion of the
waiting period. THERE WILL
BE NO EXCEPTIONS MADE TO
WAIVE THE WAITING PERIOD FOR
ANY FUTURE EMPLOYEES.
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Simplified
Underwriting
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Employer groups with 2–10
eligible enrolling employees
must complete long-form
health evidence (Section 5)
of the current 2–50
Small Group Employee
Application. Employer
groups with 11–50 eligible
enrolling employees must
complete Section 5A of the
short form health evidence
of the current 2–50 Small
Group Employee Application.
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Other
important
concepts
to help
you
understand
your
California
group health
insurance
quote
are:
Small
Group
RAFF
Why
offer
Small
Group
health
insurance
Guide to
Group
health
insurance
in
California
Download
the
health
application
or apply
online
California
group
health
insurance
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Anthem Blue Cross