Carrier

Effective RAF - Additional Information

Promotion

# Enrolled

RAF - Additional Information

Aetna Notes :

• Groups with 6 - 9 enrolling must be AB1672 eligible and have a renewal RAF of 1.0 or less with their current carrier. Groups can be medically underwritten to qualify for a RAF lower than the .95 guarantee RAF.
• Groups with 10+ enrolling must be AB1672 eligible and have a renewal RAF of 1.06 or less with their current carrier.
• Groups with 6+ enrolling that received a 10-point increase in their RAF are ineligible.
• COBRA/CalCOBRA enrollees do not count toward the enrolled employee counts.
• Groups with 30% or more 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from CaliforniaChoice, Contractor’s Choice, HSA California, Kaiser Permanente Choice Solution, or groups that have withdrawn from Aetna within 12 months of the requested date are not eligible.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.
• Employers funding a portion of the employee’s deductible, copayment/coinsurance will only be eligible for Aetna’s RAF promotion when using Aetna HealthFund HRA. (Please note: HSA plans are eligible for RAF promo when funding is through a federally qualified HSA).
• Groups coming off a PEO arrangement are not eligible.
• Effective 2/1/12, Groups are eligible for the RAF promotion either two months (60 days) before or two months (60 days) after their renewal date.

Click Here for Aetna's RAF program flyer - Through January 31, 2012

Click Here for Aetna's RAF program flyer - February-June, 2012

 

10/1/10 - 3/15/12

1.10

.90

6-50

Guaranteed .90 RAF if renewal RAF is 1.05 or less

Blue Shield Notes :

• This program is in effect for qualifying groups with Blue Shield effective dates of October 1, 2010, and later. The RAF program is available for new business only, and is subject to termination at any time.
• Program applies to Standalone, Dual Choice, Suite Deal, and PlanSelect options.
• Must provide original copy of current health carrier renewal letter with the initial group enrollment. Groups previously submitted and approved under standard underwriting guidelines will not be reconsidered or rerated under any RAF programs.
• If Blue Shield cannot validate employee eligibility based on documents provided, then standard underwriting guidelines apply.
• Program applies to guaranteed-issue small groups only. Groups must meet standard underwriting guidelines (i.e., contribution and participation), and submit the most recent quarter DE-6 and/or other required documentation to verify owner/ employee eligibility.
• Sole proprietor, partner, or corporate officer statement (C15293) is required on officers/owners who are not listed on the DE-6.
• This program does not apply to groups that are not eligible for guaranteed acceptance or groups coming off of a "special deal" or association plan, spin-offs, or group splits.
• Groups using any employer-sponsored wrap plan or product, other than an HSA or employee funded general purpose FSA, are not eligible for the RAF program.
• Groups with employees enrolling in plans that are permissible to pair with a wrap product - Shield Savings 1800/3600, Shield Savings 2250/4500, or the Shield Spectrum PPO Plan 3000 - are not eligible for the RAF program. This exclusion applies whether the plans are offered as standalone or as part of any package.
• Groups with employees enrolling in XCC plans are not eligible for the RAF program.
• Groups are eligible for the RAF reduction two months (60 days) before to two months (60 days) after their renewal date.
• Groups must have an original renewal RAF of 1.05 or lower from their current carrier; and 6 to 50 enrolling employees to qualify.
• Groups with fewer than six enrolling employees can apply for a lower RAF with the submission of health statements. The best available RAF for groups with 2 to 5 enrolling employees is 1.0.
• The RAF reduction is a first-year reduction to the RAF for new small group medical plans only.
• COBRA/CaICOBRA enrollment cannot exceed 30% of total group enrollment. COBRA/CaICOBRA enrollees do not count toward enrolled employee counts.
• Current groups with CaliforniaChoice that have had a Blue Shield member enrolled in any of the previous 12 months are not eligible for the Blue Shield RAF program.
• Current groups with CaliforniaChoice that have had no Blue Shield members enrolled in the previous 12 months are eligible for the Blue Shield RAF program.

Click Here for Blue Shield's RAF program flyer - January-March, 2012

Click Here for Blue Shield's Specialty Benefits RAF program flyer

 

Minimum 1.00

Guaranteed .90 RAF if renewal is 1.05 or less

Health Net RAF Guarantee:

• To qualify for the RAF Guarantee Program, sales must be for new AB1672 groups with:
  • A minimum of six (6) qualifying new subscribers.
  • Group effective dates of December 1, 2011, through March 15, 2012.
  • COBRA and Cal-COBRA enrollees are excluded.
• “Qualifying new subscribers” are those subscribers effective with the group on the date the group becomes effective.
• The RAF guarantee is for the full 12-month contract period.
• Choice Administrators Programs, existing Health Net groups, association groups, carve-out groups, Hn Options groups and non-guaranteed issue groups are NOT eligible.
• All other standard paperwork and Underwriting rules apply.

Click Here for Health Net's RAF Flyer

Sharp Health Plan:

• No health questionnaires or employer questionnaires required if all program criteria is met.
• All groups applying for the RAF discount must be AB1672 eligible; standard underwriting guidelines apply to non-guaranteed issue groups, to include submission of health questionnaires.
• Groups must have a renewal RAF of 1.06 or less with current carrier.
• Groups that receive a 10 point increase in their RAF at renewal are ineligible for this promotion.
• Groups must submit a copy of their current carrier renewal reflecting the renewal date and renewal RAF upon submission to Sharp Health Plan. The renewal date reflected must be within 2 months of the requested Sharp Health Plan effective date.
• COBRA enrollees do not count toward the enrolled employee counts.
• Groups with no prior coverage are ineligible for this RAF reduction offer.
• Groups who are enrolled with Cal Choice, or who have withdrawn/terminated from Sharp Health Plan are ineligible for this RAF reduction offer.
• Groups must meet all standard underwriting guidelines.
• The RAF reduction program is a first-year reduction only for new small group business.
• Groups of 6-9 may apply for a lower RAF via standard underwriting guidelines, to include the submission of health questionnaires.

Click Here for Sharp RAF Flyer

7/1/11– 3/31/12

RAF Guarantee

6 – 50

.90

United HealthCare/PacifiCare:

• Groups with 6–50 enrolling employees – Guaranteed .90 for groups with prior carrier RAF of 1.06 or better.
• Cal-COBRA/COBRA enrollees do not count toward group size.
• Groups that receive a 10-point RAF increase on their renewal with another carrier do not qualify for this RAF program.
• Groups with more than 30% of COBRA/Cal-COBRA enrollees are not eligible for this RAF program.
• Groups must meet Small Business eligibility requirements (AB1672).
• Carve-out groups (management/nonmanagement, salary/non-salary, union/non-union) are not eligible for RAF Guarantee Program.
• New groups must present a prior carrier small group renewal that reflects a renewal date within three months of the new business effective date with UnitedHealthcare or PacifiCare plans.
• Groups must apply for the RAF promotion prior to underwriting approval. A copy of the current carrier renewal reflecting the RAF/renewal census and documentation from its current carrier disclosing the amount of the RAF change must be included with the group’s initial submission to underwriting.
• Groups previously submitted and approved under standard underwriting guidelines will not be reconsidered or rerated under the RAF program.
• Groups coming from a large group contract that are now AB1672-eligible can qualify for the RAF promotion if they can provide a large group renewal of less than a 20% increase within three months of their requested effective date.
• Employer groups, with 10 or more enrolling medical subscribers, currently with a PEO and who terminate the relationship, will receive a .90 RAF (assuming they meet eligibility requirements including those specific to UnitedHealthcare underwriting guidelines for groups terminating their PEO arrangement).
• CalChoice, Kaiser Permanente Choice Solution (KP Choice), HSA California, Contractor’s Choice, existing UnitedHealthcare or PacifiCare groups (including acquisitions), Non-Guaranteed Issue, Association Group cases and groups applying for coverage with the UnitedHealthcare PremierSource are not eligible.
• PEOs are considered large group contracts, thus need to have a renewal below 20% to qualify.

Click Here for UHC's RAF Flyer