1 PRODUCERS QUICK REFERENCE GUIDE Agent Marketing Support Toll Free: In Columbia: Group Size and Proposal Rating: BusinessADVANTAGE Plans 1/1/ Adjusted Community Rates Tobacco Surcharge Size of group is determined by the number of full time eligible employees, not the number enrolled. If a business has 50 or fewer full-time equivalent (FTE) employees, it is considered a small business under the health care law. Underwriting Requirements: Required documents for submitting a new group: 1. Group Request for Coverage Form 2. Master Group Application 3. Copy of Accel-A-Rate SM (AAR) proposal 4. BusinessADVANTAGE Enrollment Application 5. Quarterly Wage and Tax Report (UCE 101 & 120) 6. Group Size Review Form 7. Small Business Health Options Program (SHOP) Attestation Form (option if elected) 8. Companion Life Master Application (optional if elected not available for SHOP plans). Life insurance offered by Companion Life. Because Companion Life is a separate company from BlueChoice HealthPlan, Companion Life will be responsible for all services related to life insurance. We must receive signed rates in order to complete the sales process for final group coverage. Participation Requirements: BusinessADVANTAGE Plans: Effective 1/1/14 Eligible Employees: Participation requirement is not applicable on the SHOP exchange or during the annual enrollment period (11/15 12/15). Groups may elect a dual option from any of the BusinessADVANTAGE plan options. This is not applicable to SHOP exchange plans. Minimum group size for dual option is two employees, with at least one employee on each option. Minimum Participation Requirement percent of total full-time, eligible employees after excluding valid waivers Valid waivers include Medicare, Medicaid, other insurance coverage and Military/Veterans programs. Individual coverage is not considered a valid waiver.
2 Plan Effective Date: 1 st or 15 th of the month. You should submit cases at least two weeks prior to the effective date to ensure that members receive ID cards promptly. Employer Contribution: Employer Contribution Requirement: 50 percent of the single medical premium rate. Contribution requirement is not applicable on the SHOP exchange products during open enrollment. 2-3 Person Groups: If a husband and wife are the only two employees in a valid group, they must enroll on separate enrollment forms. They may only enroll children under one parent. If the group has three or more employees and two of those are a husband and wife, they may enroll on one enrollment form with employee/spouse or family coverage. The employee covered as a spouse must complete a waiver enrollment form for medical/dental. The employee covered as a spouse must complete a waiver enrollment form for life insurance, offered by Companion Life Insurance Company. The covered spouse still has the option of electing the employee life insurance. If elected, the life section on the enrollment form must be complete. Waiting Periods: Effective 1/1/14 forward: 1 st of the month following 30 days 1 st of the month following 60 days 90 days (exact) If a group does not elect a waiting period, the default will be the 1 st of the month following 60 days. Employee Eligibility: All eligible employees (working a minimum of 30 hours a week, 48 weeks of the year) are eligible to enroll after meeting the waiting period. New hires must enroll within 31 days of their eligibility date. Dependent children will be covered up to age 26. NOT ELIGIBLE: Contract (1099), leased employees and management (class) carve-outs of any kind. Additional Guidelines: Pediatric dental and vision: They are considered a standard benefit for that particular plan and cannot be removed. Maternity is a standard benefit on all plans and cannot be removed.
3 Enrollment Forms: BusinessADVANTAGE Plans: Enrollment application (V ) Comprehensive Dental Coverage (Optional): Note: Not available on SHOP plans If the group elects the comprehensive dental coverage, the employee s dental election must match the medical election. Example: E/S medical = E/S dental Life Insurance from Companion Life (Optional): Note: Not available on SHOP plans A minimum of $10,000 group life and AD&D insurance is optional. A Personal Health Statement is required for amounts greater than $15,000. Eligible Employees: Increments: 2 19 $10,000 $15,000 $20,000 $30,000 $40,000 $50, $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000 $45,000 $50,000 Companion Life will underwrite and bill for all amounts over $50,000. If the employee elects only life insurance, he or she must complete the life section of the enrollment form. Dependent Life may be sold with Basic Life. The dependent life amounts are flat amounts based on group size. Eligible Employees: Covered Spouse Amount: Per Covered Child Amount: 2 19 $2,000 $1, $5,000 $5,000 The life insurance election does not have to match the medical/dental election. The employee can elect to have dependent life (if the employer offers it), and only elect single medical/dental coverage. Also, the employee can waive the dependent life, but elect to cover the family under the medical/dental plan. An Agent New Group Check List is available and indicates all required documentation needed for submission of new groups.
4 Group Size Review Form - Fax to Group Name: Group Number(s): Tax ID Number: Anniversary Date: Group Insurance Contact: Telephone: Fax: Address: 1. All employees as indicated on payroll records (question 2 plus question 3): 2. Full-time employees: 3. Part-time employees: 4. COBRA/State Continuation participants: 5. Total full-time employees including COBRA (question 1 minus question 3): A. Number of COBRA participants (same as question 4): B. Number covered by spouse on same group: C. Number serving probationary period: D. Number covered through another employer plan, Medicare, Medicaid, the military or veterans programs. (Do not include employees with individual non-group coverage.) E. Total of A through D: 6. Total number of eligible employees (question 5 minus E): 7. Total enrolled with BlueChoice HealthPlan as indicated on latest bill: Other information, if applicable: Total number of retirees covered: Number under 65 Number over 65
5 Under the Patient Protection and Affordable Care Act (PPACA), health insurance carriers are required to report their medical loss ratios (MLR) to state and federal agencies annually. 8. How many full-time equivalent (FTE) employees in your organization/company were employed in 2013?. This is defined by averaging the total number of all employees employed on business days during the preceding calendar year. This includes each full-time, part-time, and seasonal employee. 9. How many full-time employees in your organization/company were eligible for health insurance in 2013? (This number represents the 2013 average of all full-time employees, defined as working at least 30 hours per week, 48 weeks per year.) 10. Is your organization/company considered to be a sole proprietorship? A sole proprietorship is an unincorporated business owned and run by one individual with no distinction between the business and you, the owner. Yes No If yes to the above question, do you have an employee or employees other than you and/or your spouse covered under the same plan as yourself? Yes No 11. If you are a non-governmental, non-erisa plan (i.e. church plan) we need assurance if your employer group qualifies for a medical loss ratio rebate, the rebate will be used to benefit your group plan s current enrollees. Please affirm which method you will use to distribute the subscriber portion of your rebate should you be eligible for one. We will reduce the subscriber s portion of the annual premium for the subsequent policy year for all subscribers covered under any group health policy offered by the plan. We will provide a cash refund only to the subscribers that were covered by the group health policy on which the rebate is based. We will not provide written assurance of the above. We understand that BlueChoice HealthPlan will distribute 100 percent of any medical loss ratio rebate evenly and directly to our subscribers. Print Name and Title: Signature: Date: