Carrier

Effective RAF - Additional Information

Promotion

# Enrolled

RAF - Additional Information

5/1/09 - 12/31/09 Aetna Notes : Large Groups moving to Small Group must now be AB1672-eligible, and must provide a large group renewal of less than 20% increase within 90 days of their requested effective date, to be eligible. All groups must be AB 1672-eligible and have a current RAF of 1.06 or less. Current and last year’s renewals must be provided. Groups of 2–4 are guaranteed a 1.10 RAF. COBRA/Cal-COBRA enrollees do not count toward the enrolled employee counts. Groups with .10 renewal RAF increase, California Choice ® groups, groups that have withdrawn from Aetna within 12 months of the requested effective date, carve-out groups, and groups without prior coverage are not eligible for this promotion.

1/1/10 - 4/30/10 Aetna Notes :

• Groups applying for the guaranteed RAF must be AB1672 eligible and have a current RAF of 1.06 or less with their current carrier.
• Groups that received a 10-point increase in their RAF are ineligible.
• COBRA/CalCOBRA enrollees do not count toward the enrolled employee counts.
• Groups with more than 30% of COBRA/CalCOBRA enrollees are excluded from the RAF promo.
• Groups coming from CaliforniaChoice, Contractor’s Choice, HSA California, Kaiser Permanente Choice Solution, or groups that have withdrawn from Aetna within 12 months of the requested date are not eligible.
• Groups coming from a large group contract that are AB1672 eligible are eligible if they can provide a large group renewal of less than a 20% increase within 90 days of their requested effective date.
• Carve out groups (management/non-management, union/non-union) are not eligible for RAF promotions.
• Groups must submit a copy of both their current and last year’s renewal or their issued RAF at new business.
• Groups must apply for the RAF promotion prior to final underwriting approval.

Click Here for Aetna RAF Flyer

Through 3/31/10

10 point reduction

6-9

10 point RAF reduction from current RAF

Blue Shield Notes : New business only, prior carrier renewal required. Must be AB1672 eligible, and meet all underwriting requirements. Groups with no prior coverage, Cal Choice coverage, spin-offs, association plans or group splits do not qualify. If the following plans are offered stand-alone or as part of a package, they are not eligible for the RAF promotion: Shield Savings 1800/3600, Shield Savings 2250/4500, and Shield Spectrum PPO Plan 3000. Must be within 60 days (before or after) renewal. Groups must have current renewal RAF of 1.05 or lower.

California Choice ® RAF Guarantee: Current renewal RAF statement (within 3 effective dates) from their current carrier, showing a RAF of 1.0 or less to qualify for .90 RAF. NOTE: COBRA enrollees will not be counted in total EE enrollment for the RAF guarantee

Health Net RAF Guarantee: Current RAF of 1.06 or lower and AB1672-eligible. New business with 6+ enrolling, effective 1/1/09-12/31/09. Renewal must be submitted, within 3 months of the Health Net effective date. COBRA/Cal-COBRA enrollees do not count. SIC loads and discounts do not apply to groups accepting the RAF guarantee. Carve-outs and groups writing Health Net alongside another carrier are subject to review. Ineligible Groups: Groups of 2–5 enrolling employees, groups with a current RAF higher than 1.06, non-guarantee issue groups, California Choice ® and existing Health Net groups, and Association groups.
Ineligible Groups: Groups of 2–9 active subscribers, California Choice ® groups, existing Health Net groups, Association groups, and non-guarantee issue groups.

Revised renewal RAF's are not eligible for consideration

Click Here for the 2009 Health Net RAF Flyer

Click Here for the 2010 Health Net Flyer

Sharp Health Plan: New AB1672 Groups only. Must submit current renewal with 1.06 or better within 2 months of renewal. Health questionnaires NOT required if not qualified and applying under RAF program for HMO, but will be required for PPO members. PPO member’s out-of-area will be 1.0 RAF, and do not count towards participation of promotion. Groups with 2–5 enrolling employees will automatically receive a 1.10 RAF. COBRA/Cal-COBRA enrollees do not count towards eligibility/enrollment count. Ineligible Groups: Current California Choice ® groups, prior Sharp groups, or groups with no coverage.

Click Here for 1/1/09 - 12/31/09 Sharp RAF Flyer

Click Here for 1/1/10 - 12/31/10 Sharp RAF Flyer

1/1/10 – 3/31/10

RAF Guarantee

6 – 50

.90

United HealthCare/PacifiCare: New AB1672 Groups only. Must submit current renewal with 1.06 or better within 3 months of renewal. Billing statement may also be required. Health questionnaires NOT required if not qualified. Submit Health Statements if groups current carrier’s renewal census is greater than 20% in enrollment. COBRA enrollees do not count towards eligibility /enrollment count. Large Groups moving to Small Group must now be AB1672-eligible, and must provide a large group renewal of less than 20% increase within 90 days of their requested effective date, to be eligible Ineligible Groups: Groups with .10 renewal RAF increase,Current CalChoice, PacifiCare or UHC groups, Association Groups, and Virgin Groups.

Click Here for UHC RAF Flyer