Instructions/Guidelines

Transcription

1 Instructions/Guidelines I. GROUP FORM Essential Items Effective Date The rates will vary by effective date of the policy. State, Zip, County Needed to identify product availability. And, the geographic area of the employer is a rate adjustment factor (due to variations in provider compensation) Average # of Employees Identifies the market segmentation applicable to group. Small group plans are not available to large employers. Small group and large group plans differ in design and rating methodology Other Items Industry Code Industry code is required, but usually available through data services like Dunn & Bradstreet. This is used to quote every product except fully insured small group medical plans. Current Medical Carrier Needed to avoid quoting new business rates with the current carrier. Website Helpful in providing information about the nature of business in the event that the industry code is not available through Dunn & Bradstreet Standalone EHB Dental If you offer standalone dental that meets the Essential Health Benefits requirement, some carriers will remove it from the medical plan and lower your premium rates Waiting Period Helpful in identifying employees that are in their waiting period and not yet eligible for coverage. Employer Contributions Will help inform possible contribution structures for plans with "per member" rates. Required for non medical product quotes because it is a rating factor. II. CENSUS TEMPLATE Non ACA Template Used if ACA census is not sufficient. Does not include dependent data. A. Requirements by Plan Funding Structure being Quoted B. Guidelines and Important Notes Fully Insured Alternative/Self Funding The date of birth is required for all individuals enrolled in the health plan. 1. Member Type 1. Employee DOB The medical tier will be used in the event of discrepancy between dependent data and medical tier election 2. Member DOB 2. Gender Medical Tier empty cells will be treated as "D" for declining without other coverage 3. Employee Medical Tier 3. COBRA/Continuation Employees that are in their waiting period that are not marked with coverage elections will be ignored for quoting purposes 4. Member Tobacco Use (18yo+) 4. Home Zip Tobacco Use Empty cells will default to "N." Incorrect values will impact final rates. 5. Member Gender 5. Work Zip COBRA/Continuation Empty cells will default to "N". 6. Medical Tier Home/Work Zip Empty cells will default to primary headquarters location Inaccurate data will produce inaccurate quotes. Final rates determined by final enrollment C. Census Instructions Coverage Tiers Defined EE Employee Only W Waive (with other coverage) ES Employee + Spouse D Decline (no other coverage) EC Employee + Children NE Not Eligible (waiting period, part time, etc) EF Employee + Family Diagram for (ACA census) Important Optional Mandatory Optional Mandatory Mandatory Important Identifies Identifies EEs EE = Employee Helps distinguish individuals if self Applies to Mandatory Identifies separate not eligible Optional SP = Spouse Can list all dependents even those Mandatory funded / 18yo+ defined Important network offices in waiting Mandatory Any value CH = Child not enrolled on all enrolled ancillary "N" default above default "N" gaps default HQ period defined above (left) I I I I I I I I I Member First COBRA/ EE # Type Name Last Name DOB Gender Tobacco Med Tier Continuation Home Zip Work Zip Hire Date Den Tier Vis Tier EE Robert Gray 6/23/1966 M N ES N /30/2002 ES ES SP Barbara Gray 2/24/1965 F Y EE Ann Robinson 4/8/1977 F N EO N /24/2006 EO EO EE Jacqueline Lee 5/4/1975 F Y EF N /10/2006 EC EC SP Paul Lee 5/21/1970 M N CH Anthony Lee 7/28/2001 M EE Carl Jackson 12/11/1971 M N EC N /23/2007 EC EC CH Brian Jackson 3/17/2003 M

2 Small Group Quote Request Form Very important to complete all company information. Click for Instructions/Guidelines GROUP DATA Group Name Effective Date Industry Code Current Med. Carrier Website HQ Street City State Zip Code County Comments MARKET/GROUP PROVISIONS ANSWER QUESTION 1. Does employer provide standalone dental coverage that satisfies the Essential Health Benefits pediatric dental requirement? 2. Average Total Number of Employees for the last 52 weeks. This number determines market segmentation. It is the average number of employees on business days during the preceding calendar year. Average Total Number of Employees includes full time, part time, seasonal, temporary employees and employees with and without coverage employees are NOT included in the average number of employees. There is no official methodology for computing this number. One method would be to determine the unique number of employees in each month in the prior calendar year, add those numbers together, and divide by the number of months the company was in business during the year. Consult with your legal or tax advisor for assistance, if necessary. 3. (Waiting Period) On what date are new hires eligible for coverage? Beginning 1/1/14, waiting period can no longer be more than 90 days. For those groups with 90 days 1st of the following month effective date, suggestion would be to change the waiting period for new hires to 60 days 1st of the following month. EE Dep 4. What is the employer's contribution percentage towards the Employee and Dependent portions of the premium rates for each coverage? a) Medical b) Dental c) Vision d) Base Life/AD&D e) Short Term Disability f) Long Term Disability Send census information to Kathy Garza or Freddie Garza Memorial Financial Services Corp Barker Point Lane, Suite 155 Houston, TX (281) office (28) fax

3 Census for Ancillary and Large Medical Quoting This census format is NOT valid for quoting small group medical (where dependent dates of birth are required). This census is used when the "ACA Census" is not sufficient mainly for quoting life and disability products EE # First Name Last Name Employee DOB Gender COBRA/ Continuation Continuation End Date Home Zip Work Zip Hire Date Med Tier Med Plan Den Tier Den Plan Vis Tier Life Ancilary Class Salary Occupation EE SP CH vstd Volume vltd Volume

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