Connecticut underwriting brochure

Transcription

1 Quality health plans & benefits Healthier living Financial well-being Intelligent solutions Connecticut underwriting brochure Plans effective January 1, 2015 For businesses with eligible employees CT A (9/14)

2 Underwriting guidelines This material is for informational purposes only and is not intended to be all inclusive. Other policies and guidelines may apply. Note: State and federal legislation/regulations, including HIPAA and ACA take precedence over any and all underwriting rules. Exceptions to underwriting rules require approval of the Director of Underwriting, except where Executive Director of Underwriting approval is indicated. This information is the property of Aetna and its affiliates ( Aetna ), and may only be used or transmitted with respect to Aetna products and procedures, as specifically authorized by Aetna, in writing. All Underwriting Guidelines are subject to change without notice. Product Availability Medical Medical coverage may be written standalone or with ancillary coverage. Dental Standard and voluntary dental plans available with or without medical. Standalone available. Standalone dental has ineligible Industries. Orthodontic coverage is available to dependent children only. Retirees --Standard plans can comprise no more than 10 percent of the group. --Voluntary plans not eligible. Vision Single option only (dual option, triple option not available). Vision only is allowed; or can be sold with medical and ancillary products. Case Submission Dates Census Data All new business submissions must be received by Aetna on the 25 th of the previous month for the 1 st of the month effective dates; and the 10 th of the month for 15 th of the month effective date. If material is not received by this date, the effective date will be moved to the next available effective date, with a potential rate impact. Exceptions must be approved by the Underwriting Manager. The following is needed in Excel format: census is required for medical and must include first name, last name, date of birth, gender, residence ZIP codes for all enrolling employees and dependents including the physical work ZIP code for employees. The census must also include all waivers and COBRA enrollees. Sold groups may submit this via EList. Life and disability additional census information is required. Please contact your Aetna sales executive. Retirees Medical retirees are eligible. Dental cannot comprise more than 10 percent of the group. Provide census with retirees split by over and under age 65. Health/Dental insurance, dental benefits, life and disability insurance plans/policies are offered, underwritten or administered by Aetna Life Insurance Company (Aetna). 2

3 COBRA Enrollees Deductible Credit COBRA coverage will be extended in accordance with federal law. Employers with 20 or more employees (full and part time) must offer COBRA coverage. COBRA enrollees are not eligible for life, disability or voluntary dental coverage. COBRA enrollees must be included and noted on the census. Provide the qualifying event, length, start and end dates. Companies under common ownership are included in the count. COBRA is not billed separately and is included with the group bill. If the COBRA enrollee does not reside in an Aetna service area, they are only eligible for out-of-network benefits if applicable; or urgent/emergency care. Do not include COBRA enrollees for the purpose of counting employees to determine the size of the group. Once the size of the group has been determined and it is determined that the law is applicable to the group, COBRA enrollees can be included for coverage subject to normal underwriting guidelines. A high percent of COBRA enrollees may result in an additional rate up. Deductible credit applies to group-to-group takeover for individuals on the prior group plan. Employees who are eligible and want to receive credit for any amounts paid toward the deductible with their prior carrier should submit a copy of the Explanation of Benefits (EOBs) no later than 90 days after the effective date. Be sure the subscriber s Social Security number is on the EOB. EOBs may be sent with the initial submission, with the first claim, or can be faxed to no later than 90 days after the effective date. If faxed, please include ECHS Category: SFRE in the subject line with the group/control number in order to direct the information to the correct area for processing. Deductible carryover not allowed. Deductible credit applies to calendar-year plans. Not available on plan-year plans. Deductible credit reports may be submitted. Be sure it includes Social Security numbers. Dependent Eligibility Spouse of employee, same-sex civil union partner, domestic partner (same and opposite sex) if both employee and spouse/partner work for the same company, they may enroll together or separately. Children: --Medical and dental: --Children are eligible as defined in plan documents in accordance with applicable state and federal laws, up to the end of the policy year the dependent turns age 26, regardless of financial dependency, employment, eligibility of other coverage, student status, marital status, tax dependency or residency. This requirement applies to natural and adopted children, stepchildren and children subject to legal guardianship. --Children can only be covered under one parent s plan when both parents work for the same company. --When the child works for the same company as the parent, the child may enroll separately as an employee or as a dependent under the parent s plan. --Grandchildren are eligible if court ordered. A copy of the court order must be submitted. - - Incapacitated child attainment of limiting age will not terminate the coverage of the child while the child is and continues to be both incapable of self-sustaining employment by reason of mental retardation or physical handicap and chiefly dependent on the employee or member for support and maintenance. Proof of incapacity and dependency must be furnished to Aetna by the employee or the member within 31 days of the child s attainment of the limiting age and subsequently as may be required by Aetna, but not more frequently than annually after the two-year period following the child s attainment of the limiting age. 3

4 Dependent Eligibility (continued) Dual/Triple Option (medical only) Effective Date Electronic Funds Transfer (EFT) Employee Eligibility Medical and dental dependents must enroll in the same benefits as the employee (participation is not required). Employees may select coverage for eligible dependents under the dental plan even if they select single coverage under the medical plan. Individuals cannot be covered as an employee and dependent under the same plan, nor may children eligible for coverage through both parents be covered by both under the same plan. Dual option and triple option plans are allowed. HSA-compatible plans that are available as Plan Year and Calendar Year cannot be offered together as dual or triple option. Groups may offer an additional PPO/indemnity plan for out-of-state subscribers. These plans will not count toward the maximum noted above. The effective date must be the 1 st or the 15 th of the month. The effective date requested by the employer may be up to 60 days in advance. The first month s premium for new business can be processed through an Electronic Funds Transfer/ACH. Once the group is issued, customers can pay their monthly premiums online or by calling an automated phone number, , using their checking account and routing number. There is no extra charge for this service. Eligible employees are those who are permanent and work on a full-time basis with a normal work week of at least 25 hours, and who have met any authorized waiting period requirements. The employer may choose to extend coverage to employees who work a normal work week of at least 20 hours or more with approval by the underwriting manager. Coverage must be extended to all employees meeting the above conditions, unless they belong to a class excluded as the result of a collective bargaining arrangement. Ineligible employees include the following 1099 contractors, directors, stockholders, partners or other outside consultants who are not active, permanent full-time employees. Retirees The retiree must be currently covered with present carrier (must be shown on the bill roster or provide a copy of the ID card). If there were no retirees covered by the prior carrier the employee must be covered as an employee on the bill roster. The census for retirees should be split by over and under age 65. Dental retirees cannot comprise more than 10 percent of the group. Retirees are not eligible for life, disability or voluntary dental coverage. Retirees are NOT included in the total count to determine the case size. A high percent of retirees may result in an additional rate up. 4

5 Employer Contribution Medical We recommend the employer contribute at least 50 percent of the total cost of the plan or 75 percent of the cost of employee-only coverage. The employer cannot fund the deductible in excess of 50 percent annually whether through an HRA, HSA or any other arrangement, or an additional factor will be applied. Dental Standard plans employer must contribute. Excludes employee pay all plans. Voluntary plans 100 percent employee paid. If the employer pays 100 percent the group is not eligible for a voluntary plan and would get a standard plan. Employer Eligibility Excluded Class/ Carve Out Medical plans can be offered to sole proprietorships with one or more eligible employees, partnerships or corporations. Organizations must not be formed solely for the purpose of obtaining health coverage. Associations, Taft-Hartley groups, professional employers organizations (PEO)/employee leasing firms and closed groups (groups that restrict eligibility through criteria other than employment) and groups where no employer/employee relationship exists are not eligible. Dental, life and disability have ineligible industries. The dental ineligible list does not apply when dental is sold in combination with medical. Medical Employees covered under a union-sponsored plan can be excluded as a class. However, union employees are included in the total count of eligible employees in determining the case size. Carve outs are permitted, provided the minimum participation and eligibility requirements are met. Groups that carve out a specific class of employees for coverage may have an additional factor applied even if standard participation requirements are met. Dental Union employees are the only class of employees that may be excluded. However, union employees are included in the total count of eligible employees in determining the case size. Management carve outs are not permitted. Initial Premium The initial premium should be the total of the first month s premium for all products (medical, life, dental, vision) and may be in the form of a check or electronic funds transfer (EFT). Submit a copy of the initial premium check payable to Aetna or complete the EFT/ACH form (Aetna Form) and include with the new business group enrollment applications. If you supply a copy of the check, once coverage is approved you will be advised where to mail the initial premium check. If the check is not submitted, coverage will terminate retroactive to the case effective date. If the EFT method is selected, we will withdraw the initial premium from the checking account when the group is approved. This is a one-time authorization for the first month s premium only. The initial premium submission is not a binder check and does not bind Aetna to provide coverage. If the request for coverage is denied due to business ineligibility or withdrawn, the initial premium submission will be returned to the employer. If the initial premium submission is returned or declined by the bank for insufficient funds, the standard termination process will be followed. If the plan sponsor is currently with Aetna and adding medical, dental, vision, life and/or disability coverage, no premium is required. 5

6 Late Applicants An employee or dependent enrolling for coverage more than 31 days (60 days for newborns) from the date first eligible is considered a late enrollee. Applicants without a qualifying life event (that is marriage, divorce, newborn child, adoption, loss of spousal coverage, etc.) are subject to the late entrant guidelines. Voluntary cancellation of coverage is NOT a qualifying event unless it is done at open enrollment. For example, if a spouse is covered through his/her employer and voluntarily cancels the coverage, it is not a qualifying event to be added to the other spouse s plan. The spouse who cancelled the coverage must wait until the next open enrollment to be eligible to enroll. However, if each spouse has different open enrollment dates and drops coverage during their annual open enrollment period, the spouse is eligible to enroll. Medical Late applicants without a qualifying life event (that is, marriage, divorce, newborn child, adoption, loss of spousal coverage, etc.) are not allowed and will be deferred to the next plan anniversary date of the group and must reapply for coverage 30 days before the group anniversary date. Dental An employee or dependent may enroll at any time; however, coverage is limited to preventive and diagnostic services for the first 12 months. No coverage for most basic and major services for first 12 months (24 months for orthodontics). Late entrant provision does not apply to enrollees less than age five. Licensed, Appointed Producers Live/Work Only appropriately licensed agents/producers appointed by Aetna may market, present, sell and be paid commission on the sale of Aetna products. License and appointment requirements vary by state and are based on the contract state of the employer group being submitted. To become appointed with Aetna go to and click Start working with Aetna. Medical Live or work allowed as long as either the work ZIP code or the residence ZIP code is within the network 60-mile radius. Dental Live or work allowed as long as either the work ZIP code or the residence ZIP code is within the network 60-mile radius. Medicare (MSP) for CMS Reporting Each year, all carriers must report to CMS (Centers for Medicare and Medicaid Services) the number of Medicare Secondary Payer (MSP) groups and the number of employees, based on the number of employees provided by the employer. MSP is the term used by Medicare when Medicare is not responsible for paying first. This is generally when the Aetna plan would pay primary to Medicare for active employees and would pay first when there are 20 or more total employees (full and part-time) for 20 or more weeks during this calendar year or prior calendar year. --Include: full-time, part time, seasonal, temporary, union, owners, partners, officers --Exclude: self-employed persons, independent contractors (1099), directors, deased employees 6

7 Medical Underwriting Newly Formed Business The employer must complete a group medical questionnaire (GMQ) and may be rated up. Groups seeking coverage for the first time with no group medical coverage through the current employer will be required to provide individual health statements and may be rated up. Full disclosure of all claims in excess of $25,000 is required at time of proposal with copies of existing carrier s source reports. Claims on known high-cost or emergent conditions should not exceed 25 percent of premium and may be rated up. Medical conditions of COBRA enrollees are included in this rating calculation. Medical claims may be reviewed for any individuals who had prior Aetna coverage and used along with the health information included on the employee application(s) and/or group medical questionnaire, and included in the overall medical assessment of the group. Groups may be required to complete individual medical questionnaires and may be rated up. Newly formed businesses must provide the following: Sole proprietor Partnership or limited liability partnership Limited liability company Corporation A copy of the business license (not a professional license). A copy of the partnership agreement. A copy of the articles of organization and the operating agreement to include the signature page(s) of all officers. A copy of the articles of incorporation that includes the signature page(s) of all officers (must be followed up with a copy of the statement of information within 30 days of filing with the state). Each newly formed business must also provide: Proof of employer identification number/federal tax identification number; and Quarterly wage and tax statement (QWTS). If not available, provide the date when the QWTS will be filed; and The two most recent payroll records including hours worked, taxes withheld, check number and wages earned; or A letter from the group or a CPA with the following information: 1. A list of all employees, to include owners, partners, officers (full time and part time) 2. Number of hours worked by each employee 3. Weekly salary for each employee 4. Date of hire for each employee 5. Whether payroll records have been established 6. When a QWTS will be filed 7

8 Option Sales Medical All plans must meet participation rules. Other insurance offered by the same employer is not a valid waiver. Groups that do not meet participation may have an additional factor applied. Dental All dental plans must be offered on a full-replacement basis. No other employer-sponsored dental plan can be offered. Out-of-State (OOS) Employees Medical Out-of-state employees must be enrolled in a PPO plan if available, otherwise an indemnity plan. PPO is not available in North Dakota. Health coverage not available in Hawaii or Vermont. Louisiana residents employees residing in Louisiana are required to have a separate plan quoted and sold based on Louisiana rates and benefits. These employees are still underwritten as part of the group; however, the plans and rates for the Louisiana members will not be based on where the employer is located. This will require Louisiana employer and employee applications to be completed. Dental Members who reside out of state (OOS) will receive the same plan as in-state members (based on state rules and network availability). This applies to DMO, PPO and FOC dental plans. If an OOS member resides in a state that does not allow the in-state plan, those members will be placed into an available PPO or indemnity plan. Participation Medical Noncontributory plans (employer pay all plans) 100 percent participation is required, excluding all valid waivers. Contributory plans 75 percent of employees excluding those covered under a spouse s group health benefits plan, Medicare, or Medicaid must enroll in the Aetna plan, but not less than 50 percent of all eligible employees regardless of spousal and other waivers. All plans Dependent participation is not required. All employees waiving coverage must complete the waiver section of the employee application. Groups that do not meet participation may have an additional factor applied. Participation Dental Noncontributory plans (employer pay all plans) 100 percent excluding valid waivers. Contributory plans with medical or standalone (round to the nearest) 30 percent excluding valid waivers. Valid waivers Spousal group. Parental group. Standard and voluntary plans Employees may select coverage for eligible dependents under the dental plan even if they elected single coverage on the medical plan, or vice versa. Coverage can be denied based on inadequate participation. 8

9 PEO (Professional Employer Organization) Plan Change Employee Level Groups currently with a PEO may be eligible as long as the PEO provides payroll specific for the enrolling group and we can determine the size and eligibility of the group, even though the group may be reported under the PEO tax ID, the group may be considered subject to underwriting approval. A letter of intent is not needed. Medical Employees are not eligible to change plans until the group s open enrollment period, which is upon their annual renewal (except for qualified special enrollment events). Dental Employees are not eligible to change plans until the group s open enrollment period, which is upon their annual renewal. Freedom-of-Choice employees may change from DMO to PPO and vice versa at any time but must be received in Aetna underwriting by the 15 th to be effective the next month. Plan Change Group Level Medical Groups may change plans on the plan anniversary date only. Dental Dental plans must be requested five days before the desired effective date. The future renewal date of the change will be the same as the medical plan anniversary date. Prior Aetna Coverage Rates Rates or Fee History Groups that we have terminated for nonpayment must pay all premiums still owed on the prior Aetna plan before the new plan will be issued. Medical claims may be reviewed for any individuals who had prior Aetna coverage and used along with the health information included on the employee application(s) and/or group medical questionnaire, and included in the overall medical assessment of the group. Rates are composite quoted on a four-tier structure: single, couple, employee plus child(ren), family. Composite rates are based on final enrollment and require that: --No portion of the member s cost sharing, including, but not limited to, copayments, deductibles and/ or coinsurance balances will be subsidized or funded by the employer, with the exception of a federally qualified health reimbursement arrangement (HRA) or health savings account (HSA), whether insured or self-funded, including, but not limited to, a partially self-funded Section 105 wraparound, now or in the future; and --Employer is not funding the deductible of the quoted health plan through an HRA or HSA in excess of 50 percent annually or an additional factor will be applied. All quotes are subject to change, based on additional information that becomes available in the quoting process and during case submission/installation, including any change in census. Rates are based on final enrollment based on information provided on enrollment forms. If any of the information we receive is determined to be incomplete or incorrect, we reserve the right to adjust rates. New business groups may be rerated if enrollment changes by more than +/- 10 percent from the initial quote. Current and renewal rates are required at initial time of proposal. 9

10 Replacing Other Group Coverage Signature Dates Standard Industrial Classification (SIC) Codes (Medical) Total Average Employees Two or More Companies Affiliated, Associated or Multiple Companies, Common Ownership Vision Provide a copy of the current billing statement that includes the account summary showing the plan is paid to the current premium due date. The employer should be told not to cancel any existing medical coverage until they have been notified of approval. Claims experience is required. Medical underwriting is required; known high-cost or emergent conditions must be provided. The employer is required to have a history of staying with their carrier for several years. Voluntary dental provide a copy of the benefit summary to verify: --Major and orthodontic coverage; and --Preventive and basic coverage. The Aetna employer application and all employee applications must be signed and dated before and within 90 days of the requested effective date. All employee applications must be completed by the employee himself/herself. Underwriting will use a variety of tools, including Dun & Bradstreet, to verify a group s industry code and classify the business correctly. All industries eligible for medical. The employer should provide the SIC code and/or nature of business. For new business sold cases, be sure to answer the question on the employer application. If you have questions, please refer to the Addendum to New Business Input Document (Total Average Employee form) available in Producer World small-business/index-smallgroup.html. If the companies file taxes together provide a copy of the 851 tax form. If the companies do not file taxes together include a letter on company letterhead listing each company and percent of ownership for each individual. One owner must have at least 51 percent ownership in each company. Complete the Single Employer Plans form. The letter has to be signed by an officer of the company. The two or more groups may have different standard industrial classification (SIC) codes; however, rates will be based on the SIC code for the group with the majority of employees. The employer may only offer one vision plan to all employees. To enroll, submit a list of employees and dependents with vision plan indicated. The list can be sent via , Word doc, Excel spreadsheet, EList. Or, you can indicate vision on the employee application. The initial premium can be included with payment for medical, dental or life, or can be separate. No minimum participation or contribution. Waivers are not needed as participation is not required. 10

11 Waiting Period The employer decides whether or not to impose a probationary period. The probationary period must be consistently applied to all eligible employees. Benefit waiting periods (BWP) must be consistently applied to all employees, including newly hired key employees. Date of hire BWP is not available. One or two BWPs may be selected for specific classes of employees. The classes must be hourly and salary, management and non-management, or union and non-union. Changes to the BWP are allowed on anniversary only. The BWP for future employees may be the 1 st or 15 th of the month following 0 days, 30 days, 60 days, or exactly 90 days following the date of hire. For new hires, the eligibility date will be the first day of the policy month following the waiting period, not to exceed 90 calendar days from the date of hire. Policy month refers to the contract effective date of the 1 st or 15 th. --If Exactly 90 Days is selected the enrollment eligibility date will begin exactly 90 calendar days from the date of hire. --If 0 days is selected and the employee is hired on the first of the month, the effective date will be the date of hire. --If the group has a 15 th of the month bill cycle, the new hire will be effective on the 15 th of the month following date of hire. Examples 1 st of the month following the BWP 15 th of the month following the BWP 0 days Date of hire: 4/1 Effective date: 4/1 0 days Date of hire: 4/18 Effective date: 5/1 30 days Date of hire: 4/18 Effective date: 6/1 60 days Date of hire: 4/18 Effective date: 7/1 Date of hire: 4/1 Effective date: 4/15 Date of hire: 4/18 Effective date: 5/15 Date of hire: 4/18 Effective date: 6/15 Date of hire: 4/18 Effective date: 7/15 90 days exact Date of hire: 4/18 Effective date: 7/16 not 8/1 exactly 90 days from the date of hire Date of hire: 4/18 Effective date: 7/16 not 8/15 exactly 90 days from the date of hire 11

12 Dental Coverage Waiting Period Voluntary PPO and indemnity plans for major and orthodontic services employees must be an enrolled member of the employer s plan for one year before becoming eligible. DMO there is no waiting period. Discount plans do not qualify as previous coverage. Future hires waiting period applies regardless if takeover. Virgin group (no prior coverage) the waiting periods apply to employees at case inception as well as any future hires. Takeover/replacement cases (prior coverage) you must provide a copy of the last billing statement and schedule of benefits in order to provide credit. If a group s prior coverage did not lapse more than 90 days prior, the waiting periods are waived. In order for the waiting period to be waived, the group must have had a dental plan in place that covered major (and orthodontic, if applicable) immediately before our takeover of the business. Example Prior major coverage but no orthodontic coverage Aetna plan has coverage for both major and orthodontic The waiting period is waived for major services but not for orthodontic services Standard No waiting period. Creditable Prior Coverage Voluntary plans Plans that cover preventive and basic services will satisfy our requirements for having prior creditable coverage as long as the member was covered for 12 months under a dental plan within the last 90 days that included both preventive and basic coverage. You must provide a copy of the schedule of benefits to receive credit. Preventive only or discount plans do not meet the requirements for having prior creditable coverage. These groups will continue to be written has having no prior coverage. 12

13 Dental Ineligible Industries All industries are eligible if sold with medical. The following industries are not eligible when dental is sold stand-alone or packaged only with life Bowling Centers Physical Fitness Facilities Business Associations Private Households Dance Studios, Schools Professional Membership Organizations, Labor Unions, Civic Social and Fraternal Organizations, Political Organizations Employment Agencies Professional Sports Clubs & Producers, Race Tracks Miscellaneous Amusement/ Recreation Public Golf Courses, Amusements, Membership Sports & Recreation Clubs Miscellaneous Membership Org Religious Organizations Miscellaneous Services Theatrical Producers, Bands, Orchestras, Actors Product Packaging Open Enrollment Refer to dental footnotes page in the plan guide for plan availability. An open enrollment is a period when any employee can elect to join the dental plan without penalty, regardless if they previously declined coverage during the first 31 days of initial eligibility. Standard with medical or standalone Allowed employees/dependents who do not enroll when initially eligible are now eligible to enroll during a subsequent open enrollment period without being subject to the late entrant provision. Voluntary with medical or standalone Not allowed an employee or dependent can enroll at any time but is subject to the dental late entrant provision if enrollment occurs other than within 31 days of first becoming eligible unless a qualifying life event has occurred or the enrollee is less than age five. Reinstatement (applies to voluntary plans only) Members once enrolled who have previously terminated their coverage by discontinuing their contributions may not re-enroll for a period of 24 months. All coverage rules will apply from the new effective date including, but not limited to, the coverage waiting period. 13

14 Life and disability Ineligible Industries Life ineligible industries Description SIC code(s) Description SIC code(s) Hunting, Trapping & Game Propagation 971 Fire Arms & Ammunition Mining Metal Trucking & Courier Services, Except Air Mining Coal Transportation Water/Air Mining Oil and Gas Detective, Guard & Armored Car Service 7381 Nonmetallic Minerals, Except Fuels Amusement Parks 7996 Manufacturing Logging & Sawmills Membership Sports and Recreation Clubs 7997 Manufacturing Industrial Inorganic Chemicals Manufacturing Fertilizers/ Pesticides/Explosives Manufacturing Lime/ Gypsum/Stone Products County/Cities/Municipalities * Public Order & Safety National Security 9711 Asbestos Products Nonclassifiable Establishments 9999 *If police and fire staff are 20 percent or less of the group, quote will be completed. 14

15 Life and disability Ineligible Industries (continued) Short-term and long-term disability ineligible industries Description SIC code(s) Description SIC code(s) Agriculture, Forestry, Fishing Transportation Water/Air Mining Transportation Services General Building Contractors Residential Sanitary Services Highway & Street Construction 1611 Automotive Dealers & Gasoline Stations Bridge Tunnel & Elevated Highway Liquor Stores 5921 Roofing, Siding, Sheet Metal 1761 Fuel Dealers Concrete Work 1771 Security/Commodity Brokers & Dealers Construction Special Trade Contractors 1791 Real Estate Agents and Managers 6531 Excavation Work 1794 Hotels, Rooming Houses, Camps Wrecking & Demolition Work 1795 Laundry, Cleaning & Garment Services Meat Processing Beauty Shops 7231 Manufacturing Tobacco Products Manufacturing Logging & Sawmills Barber Shops Shoe Repair Shops 7251 Pulp Mills 2611 Misc Personal Services 7299 Paper Mills 2621 Services to Dwellings and Other Buildings Paperboard Mills 2631 Detective, Guard & Armored Car Services Alkalies & Chlorine 2812 Automotive Repair & Services Industrial Gases 2813 Motion Pictures Manufacturing Fertilizers/ Pesticides/Explosives Amusement & Recreation Services

16 Life and disability Ineligible Industries (continued) Short-term and long-term disability ineligible industries (continued) Description SIC code(s) Description SIC code(s) Petroleum Refining Offices & Clinics of Medical Doctors Manufacturing Asbestos Products Skilled Nursing Facilities 8051 Asbestos Products Child Day Care Services 8351 Primary Metal Industries Membership Organizations Nonferrous Foundries Service Private Households 8811 Fire Arms & Ammunition Services NEC 8999 Transportation Railroad County/Cities/Municipalities * Transportation Taxicabs/ Buses/Trucking National Security 9711 US Postal Service 4311 Nonclassifiable Establishments 9999 *If police and fire staff are 20 percent or less of the group, quote will be completed. 16

17 New business checklist It s so easy To help ensure the underwriting of your case is quick and easy, we are providing this simple checklist. 1. Employer application 2. EList -- Enrollment census must include plan selection -- Be sure to include a separate list with waivers and reason for waiving health coverage Or employee enrollment and waiver applications -- For all employees enrolling or waiving coverage -- Waivers may be submitted in a separate waiver list including the reason for waiving 3. Group medical questionnaire 4. Copy of initial premium check payable to Aetna or ACH Form 5. Electing vision benefit -- Submit the Aetna Vision Preferred static quote signed by the employer with the plan selected 6. Signed illustrative quote with sold plans marked and census Send all enrollment materials to: [email protected] Secure File Transport (FTP): If you do not have access to the FTP server, please contact your Aetna sales executive for access or visit us at Producer World. Effective dates may be the 1 st or 15 th of the month. Effective date Submission deadline 1 st of month 25 th of prior month 15 th of month 10 th of the month For help with your new case submissions contact your Aetna sales executive. Any missing information may result in the effective date being moved forward to the next available date. 17

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20 This material is for information only and is not an offer or invitation to contract. An application must be completed to obtain coverage. Rates and benefits may vary by location. Dental benefits, health/dental insurance, life and disability insurance plans/ policies contain exclusions and limitations. Not all health, dental and life services are covered. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features are subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to Aetna Inc CT A (9/14)