Qualification Rules

AB 1672 Small Group
Qualification Rules

Here's all you need to do to get affordable guaranteed health & medical coverage for your Employer group of 2 or more workers - as provided under California Law AB 1672 §10705 g, REGARDLESS of the Health Status of yourself or your employees!!!

This can even be husband and wife, if BOTH are working per SB 572.
The worst that can happen is your group gets surcharged 10% over the Standard Rates per the RAF factor §10700(u). If you have a good claims history and more employees, it could be a 10% discount.

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If all else fails, please fax us a
Paper Census

The Typical Paper Work Requirements to show that you qualify under AB 1672 for Group Medical Coverage and to get enrolled are:

A Copy of the firm's most recent DE 6 Quarterly State Tax Withholding Statement with current employment status of all employees listed. That is, part timers, new employees, terminated, etc. (see below* for owners - partners not listed) The Insurance Companies also use this form to verify Participation Rules (Minimum # of employees to be covered - Qualified waivers for credible coverage (covered thru spouse on a group plan) don't count against you §10706.)
If you do not have the most recent DE 6, we can try submitting your most recent payroll records.
Rules for those not on DE 6 (i.e. Corp Officer, Sole Proprietor, Partner)

How many of my full & part time employees must be covered?
The quote based on the census when your paperwork is actually turned in.
The Small Group Employer Application (Master Application). Some Applications require your SIC Code.
Employees and Dependents Applications
Applications or signed declinations from all employees/dependents declining coverage.
If your group had prior coverage - a copy of the previous month's group premium statement.
Completion of the COBRA/FMLA/Cal-COBRA questionnaire, if applicable.
Your company check for the first month's premium
Minimum Length of Time in Business - per §10700 w, with 2 or more employees on payroll in simple language is 3 months...
Insurance Company Interpretations
If you have to wait - check out:
Short Term Plans,
COBRA or
HIPAA from prior employment?
Insurance Company Checklists for forms, processing time and other requirements
Kaiser - See Page 2
Blue Shield - See Page 1
Health Net - See Page 6
Blue Cross - See Page 6
Aetna - See Page 50

The Small Group Reform Act - AB 1672 does not allow Medical Underwriting. Therefore, the Insurance Companies look REAL hard, at if your really a bonafide business
IRS Definition of Business.

Typical Requirements If an enrollee is not on the DE 6 quarterly wage report .

SOLE PROPRIETOR

Husband & Wife as Co-Sole Proprietors

Current Schedule 1040 C Profit or Loss from a Business

LA City Business Tax
LA County Business License
Fictitious Business Name - Los Angeles Search Ventura County
May be substituted for 1040, if not available due to the length of time in business, extension to file

Signed Statement that even though the owner is not on the DE 6 you're actually working the required 30 hours/week
Nolo Press on Sole Proprietorships
IRS Definition of Business

LIMITED LIABILITY COMPANY (LLC) MEMBER

Current Schedule 1065 K 1 (If not available due to the length of time in business or due to having received an extension to file, a Statement of Information or Articles of Organization with Operating Agreement may be substituted.)
Signed Statement attesting to actually working, etc....
Nolo Press on LLC's
Nolo Press Online LLC
IRS Definition of Business
1040 SE Self Employment Tax (Social Security)
1040 ES estimated tax
- Legal Jiffy.com

PARTNER

Current Schedule K 1.Instructions or possibly the 1065 Partnership Return (If not available due to the length of time in business or due to having received an extension to file, a Partnership Agreement Sample and Federal Tax ID appointment letter may be substituted.) The limited partners in a limited partnership are not eligible for coverage unless they are also employees appearing on the DE 6.Signed Statement attesting to actually working, etc....
IRS Definition of Business
Nolo Press on Partnerships
Nolo Press Form a Partnership: The Complete Legal Guide

CORPORATE OFFICER

Statement of Information - Domestic Stock Corporation. or Articles of Incorporation (filed and stamped listing names of all officers) Statement of Foreign Corporation (for out-of-state corporations)

Secretary of State Business Search Various forms from the Secretary of State, including Foreign Corporations Order copies of your filed records with the Secretary of State
FAQ's

Signed Statement attesting to actually working, etc....
IRS Definition of Business

Corp Tax Return - Form 1120

There are service companies that can help you expedite getting copies or filing these forms.

Try GKL at 800 446-5455

or search for the list on the Secretary of State's website.

Nolo Press on Corporations
S Corps
Nolo Press How to Form Your Own California Corporation (with Corp. Records Binder & CD ROM)

Specific Requirements by Insurance Company by Type of Business:

Aetna
Blue Shield - Page 5
PacifiCare Underwriting
Health Net - does not have specific requirements - Here are sample forms - Send in as much as you have - 6 week minimum filing
Typical (Kaiser) Flow Chart for what is needed