QUOTING GUIDE. Prepared for ABC Company October 2017

Transcription

1 LARGE LARGE GROUP GROUP QUOTE QUOTING GUIDE Prepared for ABC Company October 2017

2 TABLE OF CONTENTS Aetna... 3 Anthem Blue Cross... 4 Blue Shield of California... 5 CIGNA... 6 Health Net... 7 MediExcel Health Plan... 8 National General... 9 Nippon Life Benefits SHARP Health Plan SIMNSA Health Plan UnitedHealthcare

3 Contract Limit: Co-Broker (Request for Proposal) Member Level Census (including waivers and COBRA participants) with employee/dependent first and last names, dates of birth, gender & zip codes Will receive a Non Quote Notification (NQN) Letter groups with less than 101 Member Level Census including FTEs 75% of eligible employees (excluding valid waivers) but no less than 50% of ALL eligible employees regardless of valid waivers 75% of eligible employees (excluding valid waivers) to enroll across both carriers Minimum of 50% of eligible employees must enroll with Aetna Group may offer up to 4 plans listed on the proposal Discounts apply to the Medical premium: Medical + Dental + Disability + Life = 1.75% Medical + Dental + Disability = 1.50% Medical + Disability/Dental + Life = 1.25% Medical + Dental/Disability = 1.00% Medical + Life/Vision = 0.25% Employer sponsored and Voluntary plans Only for the first year 3

4 Contract Limit: Co-Broker (Traditional) EQ Census (including waivers and COBRA participants) Current & Renewal Rates Requirements for standard quoting (above items) with census identifying each employee s weekly hours worked (30-39 vs. 40+) Anthem Blue Cross must be sole carrier groups with less than 101 Signed Attestation Form 75% of net eligible employees (if under 75%, rates will be loaded) Net eligible: 200 eligible employees with 30 valid waivers is 170 net eligible employees EQ plans do not have a participation requirement for employees who work hours per week More than 50% of total eligible employees must enroll with Anthem EQ plans cannot be quoted alongside Kaiser Up to 2 HMO networks can be paired together (network with richer benefits will receive a load to the rates) A maximum of 2 HMO plans & 3 PPO plans (PPO/Solutions PPO/HSA/EPO) Save up to 4% on medical premium: Medical + Dental = 1% Medical + Vision = 1% Medical + Life ($25K min) = 1% Medical + STD = 0.5% Medical + LTD = 0.5% Employer sponsored and Voluntary plans Note: Anthem views voluntary dental plans with at least 60% participation to be employer sponsored, whether or not the employer makes a contribution, and will qualify for the 1% discount Only for the first year 4

5 Contract Limit: groups with less than 101 Member Level Census (including waivers and COBRA participants) with employee/dependent first and last names, dates of birth, gender & zip codes Employer Health Questionnaire Census with each employee s salary listed (estimated acceptable) Identify the number of FTEs on the RFP submission 75% of eligible employees must enroll in an employer sponsored medical plan 75% of eligible employees must enroll in an employer sponsored medical plan, and of those enrolling, a minimum of 50% must enroll with Blue Shield Groups may offer up to 4 plans listed on the proposal Effective through 12/31/17 Medical + Dental = 1.5% Medical + Life = 0.50% ($25K) and 1.00% ($50K+) Medical + Vision = 0.25% Employer sponsored plans Only for the first year 5

6 Contract Limit: Level-Funding and Self-Funding: Fully Insured: Member Level Census (including waivers and COBRA participants) with employee/dependent first and last names, dates of birth, gender & zip codes Same requirements as standard quoting groups with less than 101 Minimum of 25 enrolling for medical and minimum of 50 enrolling for dental 50% of eligible employees (valid waivers will count against participation) CIGNA requires at least 50% of total eligible employees Groups may offer up to 3 plans, at underwriting department s discretion Medical + Dental = 1.00% Medical + Life = 0.5% Employer sponsored and Voluntary plans Dependent upon underwriting s discretion at time of renewal 6

7 Contract Limit: Census (including waivers and COBRA participants) Same requirements as standard quoting groups with less than 101 A Signed Attestation Form Reconciled DE-9C Starting Line Up (SLU) 75% Enhanced Choice 55% Virgin Groups 33% Minimum of 75% of eligible employees are required to enroll across both carriers Greater of 38% of eligible or 38 employees must enroll with Health Net Employer contribution to Health Net s premium must equal or exceed contribution to Kaiser premium All plans, but only one Full HMO Network Plan Options Standalone: HMO, EOA, or PPO Dual Option: HMO/PPO, EOA/PPO, or HMO/HSA Triple Option: HMO/PPO/HSA or EOA/PPO/HSA Salud HMO y Más may be offered in any combination Medical + Dental = 1.00% Medical + Vision/Life = 0.50% Medical + Dental + Vision = 2.00% Employer sponsored plans Only for the first year 7

8 Contract Limit: 101+ Census (including waivers and COBRA participants) Same requirements as standard quoting groups with less than 101 Signed Attestation Form Minimum participation of 1 employee Minimum participation of 1 employee Groups may offer up to 2 plans When offering 2 plans, one of the options may be VP10 or VP20 No bundling discounts Not Applicable Not Applicable 8

9 Contract Limit: 2-50 Member Level Census (including waivers and COBRA participants) with employee/dependent first and last names, dates of birth, gender & zip codes Summary of Benefits for all in-force plans (Medical) Same requirements as standard quoting groups with less than 101 Not at this time Minimum of 2+ enrolling 50% of eligible employees regardless of waivers OR 75% excluding valid waivers Not at this time Based on enrolling employee size: 2 enrolled: Single option 3-15 enrolled: Dual option enrolled: Triple option 25+ enrolled: Quadruple option 30+ enrolled: Dual Network, Dual Option No bundling discounts Not Applicable as they only quote Medical Not Applicable as they only quote Medical 9

10 Contract Limit: groups with less than 101 Member Level Census (including waivers and COBRA participants) with employee/dependent first and last names, dates of birth, gender & zip codes Health questionnaire from every employee At time of sale provide Articles of Incorporation, Worker s Compensation bill and office lease agreement Attestation form may be requested at underwriter s discretion 75% of eligible employees including valid waivers Minimum of 50% on a case by case basis 40% of eligible employees Groups may offer up to 3 plans at underwriting department s discretion Medical + 1 Ancillary product = 1% Medical + 2 or more Ancillary products = 2% Employer sponsored and Voluntary plans Ongoing and will be part of the renewal package 10

11 Contract Limit: Co-Broker Census (including waivers and COBRA participants) Same requirements as standard quoting groups with less than 101 Signed Attestation Form will be needed at time of sale (located on master application) HMO: Minimum participation of 70% of total eligible population PPO: Enrollment cannot exceed 10% of total group enrollment Requires at least 50% excluding valid waivers 2 HMO (non-hdhp) + 1 PPO within same network and rates will hold If a HDHP plan is offered with buy-up to a non-hdhp plan, rates for both plans may be loaded up to 3%. No load to PPO rates, if offered More than 2 HMO plans require underwriting department s approval No bundling discounts Not Applicable Not Applicable 11

12 Contract Limit: 101+ Census (including waivers and COBRA participants) Same requirements as standard quoting groups with less than 101 Most recent DE-9C Minimum participation of at least 10 employees enrolled Groups required to meet minimum participation SIMNSA cannot be offered alongside other cross border options Only one medical plan can be offered No bundling discounts Not Applicable Not Applicable 12

13 Contract Limit: Co-Broker Member Level Census (including waivers and COBRA participants) with employee/dependent first and last names, dates of birth, gender & zip codes Same requirements as standard quoting groups with less than 101 Member level census with FTEs 75% of all eligible employees to enroll in an employer sponsored plan, and at least 50% of all (including spousal coverage waivers) to enroll with United Healthcare 50% must enroll with UnitedHealthcare Minimum of 25 subscribers to set up HMO Maximum of 4 plans 1 Narrow HMO network can be paired with the Full HMO Medical + Dental = 1.00% Medical + Vision = 0.50% Medical + Basic Life ($25K min) & Supplemental Life = 0.50% Medical + Employer sponsored STD & LTD = 0.50% Employer sponsored plans Ongoing as long as medical plans and ancillary coverage remain in-force 13

14 LARGE GROUP QUOTE Prepared for ABC Company October 2017