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Participation Rules

Video Introduction

Steve Shorr, President


AB 1672
Qualification Rules
Blue Cross-Anthem
Aetna
Kaiser
Cal Choice
PacifiCare - UHC
Health Net
Blue Shield
Health Reform
Self Funded Plans
Dental
Vision
Section 125
Disability
Resources
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Site Map
Root Home Page
 


 The number of eligible employees that enroll or  Participate in an Employer Groups along with the minimum Employer Premium Contribution for  are mandated under Insurance Code §10706.
 

Steve's Video on Participation Requirements

This is because the Companies are REQUIRED to write your company, under AB 1672 regardless of the health status of the owner or employees, the law and Principles of Insurance require that the Insurance Companies write the healthy ones too, so as to spread the risk.  Not just those that "need" or are going to use the coverage.  This is also knows as "adverse selection."  If an employer is not covering the  employees... the health plan might not qualify as  tax deductible business expense.

Insurance Companies specifically enforce participation when you 1st apply. Renewal enforcement

is sporadic with most companies, with Cal Choice almost always requiring recertification.

Just Send us your DE 6 or 9 Quarterly Wage and Withholding Report,  - we can work with you - to qualify by:

excluding part timers

those with other Group Employer - Spousal - or Governmental Coverage, etc.  (10705 (g))

so that your company can qualify for the coverage that you need.

Management Carve Outs
Management Carve Outs

The best way to view the Participation & Underwriting Requirements for each company, is  to get a FREE quotation for your company, then view the requirements for the companies whose plans & rates that you like.
Plan and Rate Details
Then Scroll down and click on this icon
Enrollment Eligibility

You might consider paying 99% of the least expensive plan, so that ALL employees can afford it and then let those that want better plans pay the difference. 

Our Quote Engine - on the "Agents End" can give you Employee Worksheets - showing the contribution for each employee for each plan that they might pick.
 

The employee portion can be tax deductible if you sent up a Section 125 POP plan.

Thoughts on Medi-Cal waiver from participation

Parent Page Proof in Biz Participation Rules Requirements Definitions Resources Fight for your rights
Offering Different Plans? Management Carve Out Common Ownership Census Form
 

Small Biz Tax Credits Participation Rules Individual Plans? Managemt Carve Out AB 1672 Common Ownership Health Reform

Links

Company Participation & Underwriting Rules Spread Sheet   Warner Pacific

Some Insurance companies might consider the non union employees as guaranteed issue, if the employer is mandated under a collective bargaining agreement  to contribute to Union Labor Fund.  Blue Shield Quick Underwriting Guidelins Page 5

Management Carve Out

Similarly Situated Individuals

Blue Cross
Employee Elect Portfolio:
75% of the eligible employees

BeneFits Portfolio: A minimum of 60%

Blue Shield
Health Net
Pacificare

 

Extra 6 week or more waiting period for Part Timers SB 1790 - Insurance Code §10700 f 1 d

HIPAA for when COBRA ends

Simple explanation of AB 1672 & Rating Adjustment Factors (RAF) CHCF Site
Small Group Rules CHFC Website

Proof in Biz Participation Rules Requirements Definitions Resources Fight for your rights

Enforcement of Participation Rules in the Application
Blue Cross Application

 

Broker ONLY

Blue Shield 1/1/2011 Bulletin - Same Participation ALL Plans

 

  

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