When to
Enroll.
Officially, the carriers
are pretty flexible
about receiving
enrollment applications
for new Group health
insurance plans but it's
best not to wait till
the last minute.
We can overnight
paperwork typically up
to the 5th of the month
in which you want to be
effective (on the 1st).
That being said,
Ideally, we want to
submit the paperwork at
least two weeks prior to
your requested effective
date. For example,
if you want a September
1st effective date, we
would want the paperwork
in our office by the
August 15th.
Again, we can submit it
all the way up to Sept
5th but that does not
account for issues that
may come up. The
two week time table is
important in case
employees need to cancel
other coverage which
typically requires
notification before the
1st of the month
(September 1st in our
example).
From the time we get the
paperwork, we scrub it
immediately for missing
information. It
usually takes
2-3 days to retrieve the
missing info (see What
slows down the process).
We then overnight the
packet to underwriting
at the health insurance
carrier. We
usually hear back from
them in 3-4 business
days regarding any
additional requirements.
Once we respond to
those, we typically have
a confirmation back in
2-3 business days.
This accounts for the
two week ideal
requirement.
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What paperwork should I
have ready?
This is a quick list of
what is required in
order to apply for
coverage.
-
Employee
Application
for
each
employee
and/or
owner
(download)
-
Most
recent
DE6
(State
quarterly
payroll
report)
-
Officer/Owners
complete
Sole
Proprietor/Officer
statement
(download)
-
Company
documents
as
listed
for
particular
type
of
business
on
the
Sole
- -
Proprietor/Officer statement. i.e. Articles of Incorporation
and
Statement
of
Information for a Corporation
- First month's premium made to the carrier on Company check
More
info
on
required
paperwork:
Employer
Application
This
is
main
document
relating
to
the
company
information.
Plan
selection
and
eligibility
requirements
are
also
handled
here.
There
may
also
be a
Cobra
form.
The
Cobra
form
only
applies
if
the
company
had
a
prior
Group
plan
for
which
there
are
employees
on
Cobra.
Employee
Application
This
is
the
form
specific
to
each
employee,
their
dependents
and
plan
selection.
If
an
eligible
employee
is
declining
coverage,
they
need
to
complete
either
specific
sections
(2
and
4
with
Cross
for
example)
or a
Declination
of
Coverage
depending
on
the
carrier.
If
an
employee
declines
coverage
and
is
not
on
another
group
plan,
they
will
likely
have
to
wait
till
aniversary
date
to
come
back
on.
If
they
are
choosing
an
HMO,
they
will
also
need
to
select
the
Primary
Care
Physician
or
HMO
medical
group
here.
DE6.
This
is
the
quarterly
payroll
report
to
the
State.
It's
an
official
document
that
lists
out
amounts
payed
and
taxes
withheld
on
behalf
of
employees.
If
your
company
uses
a
payroll
service,
they
will
likely
have
this
document.
The
carrier
will
use
this
to
determine
the
total
pool
of
eligible
employees.
Officer/Owners
statements.
For
enrollees
NOT
on
the
DE6
(essentially
who
are
not
on
payroll),
we
need
to
submit
an
Officer
statement
(each
carrier
has
own
version).
The
first
month's
premium
is
required
with
the
application
for
medical,
dental,
and
vision
(as
applicable).
The
check
must
be a
company
check
and
it
is
made
out
to
the
Carrier.
We
can
provide
an
amount
for
you
based
on
your
plan
selection
and
census
information.
You
can
also
run
an
instant
quote
here.
Ideally,
you
can
overnight
this
information
to
us
at
least
two
weeks
prior
to
your
requested
effective
date.
Back
to
Top
What typically slows
down the process?
These are the most
common issues we find in
our experience of
enrolling Small Groups
(2-50 employees) in
California health
insurance.
By law, California
group health insurance
is Guaranteed Issue.
This means they cannot
decline coverage for
2-50 employee sized
companies based on
health and they can go
no more than 10% higher
than the standard rate
(also called the RAF or
Risk Adjustment Factor).
In order to qualify for
this, there are three
main requirements that
frequently come up.
1)
We need at
least two people
formally tied to the
company for half of the
prior calendar quarter.
This is the snag for
small companies (mom and
pop) and for brand new
companies.
The enrollees must show
on either the DE6 or
Officer Statement.
Sometimes, a small
family business will
have a
sole-proprietorship and
the spouse is not on
payroll. In this
case, there is only one
person officially tied
to the company (via sole
proprietorship) even if
they are married.
"half the prior
calendar quarter".
This is critical for
newer companies.
For people on the DE6,
they will look to see
their payroll started
before this timeframe.
For example, if we want
an October 1st effective
date or later, we need
two people formally tied
(DE6/payroll and/or
Statement of
Information) before
August 15th. For
Jan 1st, we need two
before Nov 15th and so
on. Let's say your
Statement of Information
is stamped by the State
August 20th for
Officers. The
company would have to
wait till Jan 1st (not
qualified for the
October 1st).
Let's say that two
employees show on
payroll starting August
5th. We could then
qualify for the October
1st. This part can
be confusing so please
contact us with your
particular situation and
we can quickly size it
up.
Out of State or
Foreign Corporations.
Some companies
incorporate in other
States. They need
a Certificate of
Qualification within
California which
essentially allows them
to do business here.
The carrier will go
based on when that is
filed...not the original
incorporation.
LLC's. The
carrier will go based on
the start of the LLC
(State stamped date) if
it lists the Managers
(need at least two
enrolling).
2)
We need at least 75%
of the eligible
employees to go with the
plan. This
comes up with small to
mid-size groups where
employees are declining
coverage. Some
quick notes on the
definition of
"eligible".
1099's 1099
or contract employees
are not considered
eligible for California
group health insurance
Part Time
Employees working under
30 hours weekly can be
included or not
depending on what the
group chooses. If
the company chooses to
cover part time, they
then figure into the 75%
calculation
On other Group Plan.
Employees on another
qualified Group health
plan are not part of the
eligible pool.
They will still need to
decline coverage via the
employee application
mentioned above but they
will not affect our 75%
calculation.
Where we see an issue on
this requirement is when
we have 3 employees who
want to enroll and 2 who
do not (and they do not
fall under the above
waivers).
A side rule to this is
the majority rule in
California for
companies with employees
in other states.
At least 51% of total
(not just eligible)
employees need to be
California.
3)
The company must pay
at least 50% of the
employee premium.
This requirement does
not apply to dependent
coverage.
Some carriers allow a
fixed dollar
contribution or a fixed
percentage of a given
plan. Blue Cross
of California pioneered
this approach and it has
been very popular.
The main concern is that
the company applies the
same rule to all
employees and does not
discriminate
contributions for
eligible employees.
Paperwork Issues.
Most issues arise from
these three main
requirements. In
terms of the paperwork,
these are the most
common delays.
Employer
Application.
Officer/Owner signature
missing. Confusion
in calculating eligible
employees (we can help
here).
Essentially, we need to
address everyone who is
on the DE6 and/or
Statement of
Information.
Subtracting out the
Terminated employees,
Part-Time employees (if
not covered), and
employees on another
Group plan, we have our
number of Eligible
Enrollees.
Subtracting out those
that are voluntarily
declining and not on
another group plan, we
have our number of Enrolling Employees.
This needs to be 75% or
more of the total
Eligible Employees.
Employee Application.
-Missing signatures and/or initials.
-HMO Primary Care Doctor and/or dentist code not entered.
-Choice of Medical and/or Dental plan not listed.
-Dependent information not complete (height/weight/disabled, etc).
-Medical history information not complete (missing dates, results, etc)
DE6
-Part time employees with high salary need to be addressed
-Terminated employees need to noted (can write "Term")
-Company name/address different.
-Employees not listed on payroll (example new employees...need to submit
separate payroll report).
Corporate Paperwork
-Articles are out of State. No stamped date by State or too recent.
-Statement of Information not stamped by State.
-Officers listed on Statement but not enrolling in plan
-Company name and/or address different. Need to address.
-LLC Formation document does not list Managers
Company Check
-Different address/company name.
-Personal Check
-Amount not correct (or within 10% depending on the carrier)
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What about questions
from employees?
We
will be happy to handle
any questions from your
employees regarding plan
options and transition.
This is actually better
than an in-person
meeting with the whole
company since each
employee's health
information directly
affects their choices
and the venue for
discussing this is best
when it's one on one.
The employer actually
does not want to know
health requirements or
issues to avoid legal
liability. Each
employee can contact the
designated
representative from our
company or
Contact us directly.
We will provide
courteous and
experienced service to
all your employees.
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Can I walk through
the applications with
some one?
WOf Course. We
provided the information
on this page for those
who want research it
themselves but we would
really hope that you
allow us to assist you
through the process.
We can greatly speed up
the application
enrollment process.
Please take advantage of
this service.
Contact us
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Do
we qualify for
California Group
coverage?
Take a look at the
three main
requirements for
California Small Group
health insurance.
This is really what
causes problems for 99%
of the companies that do
not qualify. We
would be happy to help
guide you for your
company's particular
situation.
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After we enroll,
what can I expect?
iWe work with you a
daily basis throughout
the enrollment process
to expedite processing.
Once the company is
enrolled in the system,
a welcome kit will be
sent from the carrier in
3-5 business days to the
company's address on
file. Withing this
kit, you will receive
the Employer's handbook,
Employee ID cards and
policies. Our
service does not stop
there. We are then
your servicing agent for
the life of the policy.
Employee additions,
terminations, changes
can all be handled
through us. This
is important as we check
to make sure faxed
changes are processed
correctly. When
you deal directly with
the carriers,
occasionally things fall
through the cracks so it
is important to have a
third party to make sure
your changes are
processed correctly.
When dealing with
employees health
insurance, this level of
security is invaluable.
We can also help you
review your benefits for
changes, additions, etc
especially if there is a
Statewide rate increase
or change in needs at
your company. The
rates are best so we are
focused on building long
term relationships with
our clients. 99%
of the companies we have
on board have never left
or cancelled our
services.
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Do the carriers have
different requirements?
The carriers all pretty
much go by the same
State requirment for
Guaranteed Issue.
That isn't to say that
some carriers can be
easier to deal with or
apply better rate
guarantees based on the
size of the group.
The carriers are always
changing and rotating
their incentives to new
groups so we keep up
with the best options
and values today on the
market.
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HOW DO WE ENROLL IN
CALIFORNIA GROUP HEALTH
INSURANCE?