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
Note: When the employer contributes 100% towards employee premium, 100% of the eligible employees must enroll (excluding any valid waivers). |
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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). |
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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). |
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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* 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. |
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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). |
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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%. |
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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:
Note: Kaiser does not require 100% participation if the employer is contributing 100%. |
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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. |
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Note: When the employer contributes 100% towards employee premium, 100% of the eligible employees must enroll (excluding any valid waivers). |
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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). |
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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). |