Updated Carrier Underwriting Guidelines

10/14/11

Click Here to go to the Updated Small Group Carrier Guidelines

Here are the updates that have been made to the Small Group Carrier Guidelines:  

Blue Shield:

• Carrier Wrap Guidelines – Added the new guidelines for offering Blue Shield’s new January plans alongside another carrier’s HMO plan.
• Carve Out Criteria – Amended guidelines for writing location, salary vs. hourly and union carve outs currently with Blue Shield.
• HRA Eligibility – Added new guidelines for writing an HRA plan effective January 1 with the new Simple Savings plan.
• Multiple Plan Options – Added the new guidelines for offering multiple plans with Blue Shield’s new January plans.
• Participation Guidelines- Added the new guidelines for participation for Blue Shield new plans effective January 1. 
• Spin Off – Added clarification to guidelines that state 50% of a spin off group must have been insured with the prior Blue Shield plan under the prior employer.
• Union Carve Outs – Clarified the guidelines for writing a union vs. non-union group under guarantee issue for groups of 2 to 50 employees (51 to 299 is non-GI in all cases).

Sharp:

• Carrier Wrap Requirements – Removed all language regarding their old PPO plan, which is no longer available for new sales.
• Carve Out Criteria – Amended to show current guidelines for writing a carve out with Sharp.
• Multiple Plan Options - Removed all language regarding their old PPO plan, which is no longer available for new sales.
• Out of State – Added new guidelines for writing groups with out of state employees.
• Participation Guidelines - Removed all language regarding their old PPO plan, which is no longer available for new sales.

United Healthcare:

• Carrier Wrap Requirements – Amended guidelines to reflect new PremierSource plan options available November 1st. 
• HRA Section – Updated to reflect UHC’s new plans available to write with an HRA starting November 1st. 
• Multiple Plan Options – Updated guidelines to reflect UHC’s new guideline for writing select full network and reduced network HMO plans together.

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