Carrier

Effective RAF - Additional Information

Promotion

# Enrolled

RAF - Additional Information

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

• Groups with 10-50 enrolling employees will receive a maximum .90 RAF
• Groups with 5-9enrolling employees will be medically underwritten to determine their RAF
• Groups with 2-4 enrolling employees will receive an automatic 1.10 RAF
• No health statements required
• Groups with more than 30% of the Cobra/CalCobra enrollees are excluded from the RAF promo
• Carve out groups (management/non-management, union/non-union) are not eligible for RAF promotions
• Groups must submit a copy of  both their “original” current and prior renewal or their issued RAF at new business. No revised renewals will be accepted. Aetna will only accept the original renewal. 
• Groups that receive a 10 point increase in RAF are ineligible for this promotion
• Groups enrolled with CalChoice, Contractor’s Choice, HAS California, KPChoice Solutions and/or that have withdrawn from Aetna within 12 months of the requested effective date are not eligible.
• CalCobra/Cobra enrollees do not count toward the enrolled employee counts
• AB1672 eligible groups moving from a large group contract are now available for Aetna’s small group RAF program. To qualify groups must provide a large group renewal of less than 20% increase within 90 days of their requested effective date.
• Groups must apply for the RAF promotion prior to final underwriting approval.
• Promotion extends to groups that currently have an RAF of 1.06 or lower with their current carrier

Click Here for Aetna RAF Flyer

Through 6/15/10

10 point reduction

6-9

10 point RAF reduction from current RAF

Blue Shield Notes :

• Renewal RAF of 1.05 or lower from current carrier
• Groups of 10+ enrolling employees: Guaranteed .90 RAF  
• Groups of 6-9 enrolling employees: 10-point reduction
• No health statements or employer questionnaire needed
• Provide original copy of current health carrier renewal letter at 1.05 RAF or lower
• Groups are eligible for the RAF reduction two months (60 days) before their renewal month to two months (60 days) after their renewal month
• Groups may apply for a lower RAF with standard underwriting guidelines and the submission of health questionnaires
• This program does not apply to groups that do not currently have coverage, groups that are not eligible for guarantee acceptance, groups coming off of a special deal or association plan, spin off or groups currently enrolled with CalChoice.
• Groups using any employer sponsored wrap plan or product, other than an HAS 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 3000, are not eligible for the RAF program. This exclusion applies whether the plans are offered as standalone or as part of any package.

Health Net RAF Guarantee:

• Available to groups with current competitor renewal of 1.06 or lower
• Minimum of 6 qualifying new enrolling subscribers
• Groups of 6-9 enrolling employees: Guaranteed .95 RAF
• Groups of 10+ enrolling employees: Guaranteed .90 RAF
• No health statements required
• Groups of  6-9 enrolling employees may provide health statements to qualify for a lower rate
• New group must submit a copy of their current carrier renewal. Revised renewal RAF’s are NOT eligible for consideration. 
• New group’s renewal must be within three effective dates of Health Net’s original effective date (i.e., January 1st Health Net group whose other carrier renewal date falls between October 1st and April 1st)
• For groups applying for a lower RAF: Standard underwriting guidelines apply
• CalChoice, existing Health Net groups, association groups and non-guaranteed groups are NOT eligible
  

Click Here for the 2010 Health Net Flyer

Sharp Health Plan:

• Available to groups with a current renewal of 1.06 or lower and be AB1672 eligible
• New groups must have a renewal with their current carrier within 2 months of the Sharp Health Plan effective date. Groups must submit a copy of their current carrier renewal reflecting the renewal date and renewal RAF upon submission to Sharp Health Plan.
• Groups 6-9 enrolling employees: Guaranteed .95 RAF, No Health Statements required. May apply for a lower RAF standard underwriting
• Groups 10+ enrolling employees: Guaranteed .90 RAF, No Health statements required.  
• Current CalChoice groups, groups that have withdrawn or left Sharp Health Plan within the last 12 months of the effective date and groups that received a 10 point RAF increase are ineligible for this offer.
• Cobra/CalCobra enrollees do not count towards group size.
• Groups 2-5 enrolling employees will automatically receive a 1.10 RAF
• Groups with no prior coverage do not qualify for this promo

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

1/1/10 – 6/30/10

RAF Guarantee

6 – 50

.90

United HealthCare/PacifiCare:

• Groups with 6-50 new enrollees with a 1.06 or lower RAF from their current carrier
• New groups must present a prior carrier renewal that reflects a renewal date within three months of the new business effective date with Pacificare or United Healthcare
• When the current carrier renewal does not reflect the enrolled census, include a copy of the current carrier bill
• Groups with enrollment in more than one carrier (ex. Kaiser Wraps) must meet requirements. Group’s current renewal census must match enrolling employees in United Healthcare and/or PacifiCare. Individual health statements are required from enrolling employees not included on the renewal census. (ex. Wrapping the group with Kaiser)
• Groups that receive a 10 point RAF increase on their renewal with another carrier do not qualify for this RAF program
• Carve out groups (management / non management, salary / non-salary) are not eligible for RAF program
• Groups of 6-50 enrolling employees: Guaranteed .90 RAF without health statements
• Groups coming from large group contracts that are now AB1672 eligible can qualify for the RAF promotion if they can provide a large group renewal of less than 20% increase within 90 days of their requested effective date.
• CalChoice, KP Choice, Contractor s Choice, existing PacifiCare or United Healthcare groups, Non- Guarantee-issue and Association group cases are NOT eligible. CalCobra / Cobra enrollees do not count toward group size.
  

Click Here for UHC RAF Flyer