| The following email excerpts show how we explained to an Insurance Company that they were interpreting AB 1672 to narrowly, so that our client would qualify for Guaranteed Issue Employer Group Coverage. *********************************************
Still a long shot with documentation
We are waiting to find out about how to proceed with an escalation process per your request. I will be touch with you shortly.
Attached are the underwriting guidelines for .... through the ... program. Please note on the 2nd page, under Proof of Ownership Documentation the section labeled Husband and Wife groups".
Per our guidelines the underwriting department is requesting the most recent quarterly wage (DE 6or 9)report.
***I disagree with your assertion that a DE 6 or 9 is required. They are PARTNERS and are not subject to payroll taxes. AB 1672 says they are eligible. We can get you their accounting records from 1/27/2007 till now, how's that?
Insurance Code 10705 (g) No carrier shall reject an application from a small employer for a benefit plan design provided:
(1) The small employer as defined by paragraph (1) of subdivision (w) of Section 10700 offers health benefits to 100 percent of its eligible employees as defined in paragraph (1) of subdivision (f) of Section 10700
. or annual tax documentation (IRS Schedule K-1)
***They are only required to have been in biz since 5/15/2007 - so how can they have a K-1? We can get you the #'s as if they were to file a K-I July 31, 2007
§10700(w) "Small employer" §10700. means either of the following:
(1) Any person, proprietary or nonprofit firm, corporation, partnership, public agency, or association that is actively engaged in business or service that, on at least 50 percent of its working days during the preceding calendar quarter, or preceding calendar year, employed at least two,
for both partners. I spoke to Mr. G... about our guidelines on 6/27/07, I told him at this time we couldn't qualify his business. I also told Mr. G... what needs to be done if he still wanted to pursue this insurance. If you are able to provide the 2nd quarter DE-6, I can submit your group to underwriting.
***We are asking that you submit this to underwriting, as the law requires it.
10705(h) No carrier or agent or broker shall, directly or indirectly, engage in the following activities:
(1) Encourage or direct small employers to refrain from filing an application for coverage with a carrier
***They want to file with ....xyz Insurance Company
because of the health status, claims experience,
***Do husband & wife groups have a worse claims experience?
industry, occupation, or geographic location within the carrier's approved service area of the small employer or the small employer's employees
Unfortunately, at this time, the documentation provided does not meet with the underwriting guidelines for the ... program.
***See the law above. They are working full time as PARTNERS Approval procedures, applications, see 10 Calif. Code of Regulations §2209
     
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