California Small Group Health - Knowledge Base - American Alliance Insurance Brokers

Special Enrollment Period (SEP)

Aetna

Application Period: 11/15/18 – 12/15/18 for a 1/1/19 effective date

Submit to AAIB: 12/10/18
Submit to Carrier: No later than 5 p.m. on 12/15/18
Approved by: 12/15/18 – Groups must be complete and have all missing items in by 5 p.m. on 12/15/18, no exceptions for missing items.
Underwriting Requirements: No minimum participation or employer contribution requirements. All other standard carrier requirements must be met.
Can the group be written alongside another carrier?: No
Will existing SEP groups be re-certified on 2018 and future renewals?: No. but Aetna submits a recertification to groups 6 months prior to their renewal.
Does the 12 month away rule apply to groups that would like to elect the SEP this year, but have voluntarily or involuntarily lapsed coverage in the previous 12 months?: Yes

The Minimum Employer Contribution

Aetna	50% of the employee premium $80/employee Actual cost of the plan Note: When the employer contributes 100% towards employee premium, 100% of the eligible employees must enroll (excluding any valid waivers).
Anthem Blue Cross	Traditional: 50% of employee premium Fixed-dollar option: $100/employee (in $5 increments) Percentage and plan option: 50% toward a specific plan, chosen by the employer Note: When the employer contributes 100% towards employee premium, 100% of the eligible employees must enroll (excluding any valid waivers).
Blue Shield of California	Traditional: 50% of the total employee rates Defined contribution: $100/employee or the cost of the total employee rates, whichever is less Groups can now contribute a percentage for an employee and a dollar amount for dependents, or vice versa (there is no minimum contribution requirement for dependents). Note: When the employer contributes 100% towards employee premium, 100% of the eligible employees must enroll (excluding any valid waivers). Blue Shield will allow 2 different class contributions as long as both classes are clearly defined and both contribution amounts meet the minimum requirements. It is the group’s responsibility to administer themselves.
CaliforniaChoice	Employer must contribute at least 50% of the total cost for the lowest cost employee medical plan. The following medical contributions are available: a. Percentage based on the least cost HMO/EPO and specified benefit level* b. Percentage based on least cost PPO and specified benefit level* c. Percentage based on most expensive HMO/EPO* d. Fixed amount for EE only e. Fixed amounts for EE and dependents f. Fixed amount for EE, remainder to dependent(s) g. Percentage of any benefit plan h. Percentage based on specific carrier and HMO/EPO benefit level i. Percentage based on least cost HMO/EPO j. Percentage based on least cost PPO k. Percentage based on specific carrier and PPO benefit level l. EE pays fixed amount based on specific carrier and HMO/EPO benefit level m. EE pays fixed amount based on specific carrier and PPO benefit level If no HMO plan available to Employee, contribution will be based on least cost PPO plan. Note:* If employer contribution is 100%, employees cannot waive due to cost or individual coverage. Additionally, 70% of eligible employees must enroll including those with other group coverage.
Covered CA for Small Business	Min. 50% of the lowest cost employee-only premium in their selected metal tier(s). Min. 50% towards the group’s reference plan. Note: When the employer contributes 100% towards employee premium, 100% of the eligible employees must enroll (excluding any valid waivers).
Health Net	Traditional: Min. 50% contribution of the lowest-cost plan Fixed dollar: $100/employee Note: Health Net does not require 100% participation if the employer is contributing 100%.
Kaiser Permanente	The contribution can be a percentage or flat dollar amount. Minimum contribution must be at least 50% of the employee premium for the lowest-priced medical plan offered by the employer. Employer may select a percentage of the premium based on one of the following: Lowest-priced medical plan offered by the employer All medical plans offered by the employer Note: Kaiser does not require 100% participation if the employer is contributing 100%.
MediExcel	Sole carrier: No minimum employer contribution is required. Alongside another carrier: Dollar amount of the employer’s contribution to MediExcel should be no less than 80% of the dollar amount of the employer’s contribution to the other CA health plan (not to exceed 100% of the MediExcel premium). Note: MediExcel will allow 2 different class contributions as long as both classes are clearly defined and is no less than 50% of the employee only premium.
Oscar Health Plans	50% of the employee premium $100/employee Note: When the employer contributes 100% towards employee premium, 100% of the eligible employees must enroll (excluding any valid waivers).
Sharp Health Plan	Traditional contribution: 50% of employee premium Defined contribution: $100/employee Note: When the employer contributes 100% towards employee premium, 100% of the eligible employees must enroll (excluding any valid waivers). Sharp will allow 2 different class contributions as long as both classes are clearly defined and both contribution amounts meet the minimum requirements. It is the group’s responsibility to administer themselves.
UnitedHealthcare	50% of employee premium or a minimum of $100 of the employee premium Note: When the employer contributes 100% towards employee premium, 100% of the eligible employees must enroll (excluding any valid waivers).