NEWSROOM

Small Group Underwriting Promotion

New groups effective 10/1/26-3/1/2027 will have a 25% participation requirement for all groups 2-100 lives - no waivers form needed. No DE 9C is required if prior invoice is received. Without the prior carrier bill, the standard UW guidelines apply. 

Existing Anthem groups written alongside Health Net will allow members to come to Anthem as a special enrollment effective 10/1/26-3/1/27.

Groups will be allowed to reinstate within 60 days of leaving Anthem if the group left in good standing. Group will be required to pay the back premium all at once. 

Eligible small groups with effective dates 10/1-3/1 can receive a premium credit equal to one month of dental and vision premium when moving from Health Net and enrolling the group in a qualifying Anthem dental and vision coverage.  After Month 2, a premium credit equal to one month of dental and vision premium is applied to the group’s Month 3 invoice. 

Large Group Underwriting Promotion

For Kaiser Permanente participation, Anthem requires 50% minimum participation - (50% Anthem and 50% Kaiser/Waivers combined.

If alongside Kaiser, Anthem can use Pilot40 to quote down to 40% Anthem Participation as long as the anticipated Anthem population is greater than 75 enrolled, and the Kaiser enrollment is less than the anticipated Anthem population.

Small Group Underwriting Promotion

• When writing Blue Shield of California (BSCA) alongside another carrier’s HMO, the minimum enrollee requirement is 3 employees. 65% participation is required between all carriers. 
• For groups transitioning from Health Net with 3+ enrolling employees, a prior bill may be used in lieu of the DE 9C/Payroll. 
• For transitioning Health Net groups, the 30-day advance submission and six-month BSCA requirements are temporarily waived for renewal date change requests, including eligible off-cycle changes. 
• If an existing BSCA group was written alongside Health Net, members losing coverage can transition to a BSCA plan. 
• Groups that left BSCA can come back by reinstating their prior coverage within 60 days of the termination date with same group number and same member IDs. 

Large Group Underwriting Promotion

Bonus

• 1-50 members = $100 per member
• 51-100 members = $150 per member
• 101+ members = $200 per member

• $20 per member

• $5 per member

Small Group Underwriting Promotion

• Health Net invoices must be fully reconciled.
• A current pay stub is required for any subscriber not listed on the invoice.
• Owners enrolling who are not listed on the invoice must provide a signed Owner/Partner Statement.
• At least 51% of eligible employees must be located in California.
• Owner only groups are not eligible.
• All standard CaliforniaChoice eligibility criteria apply to this promotion.

Bonus

Large Group Underwriting Promotion

Bonus

• Bonus: $20 per Medical member and $5 per Dental member
• Eligible Effective Dates: Q4 2026 and January 1, 2027
• Payment Timing: Spot bonus payments will be issued 60 days following the group's effective date.
• Eligibility: Groups with fewer than 25 enrolled members are not eligible

Small Group Underwriting Promotion

• No DE 9C required for five or fewer subscribers; a Health Net bill is sufficient (does not apply to groups purchasing a Kaiser Permanente PPO plan).
• Existing Kaiser Permanente groups may move to a 1/1, 2/1, or 3/1 effective date to align with another carrier's renewal date.
• Existing groups may request upgrades, downgrades, or plan additions within 60 days of losing Health Net coverage. When adding a Kaiser Permanente PPO, the Health Net bill, Plan Change Form, and DE 9C or payroll will be required.

Bonus

• 3 Groups: $500
• 6 Groups: $1,000
• 10 Groups: $1,500
• 20 Groups: $4,000
• 21+ Groups: $500 per Group 

Small Group Underwriting Promotion

• Off-cycle renewals accepted – Groups do not need to wait for their current renewal date.
• Short-term contracts available – For groups transitioning to MediExcel ahead of their current renewal.
• Extended contracts available – To align MediExcel with a group’s U.S. carrier renewal date.
• Simplified underwriting documentation – With the most recent Health Net invoice, MediExcel will waive the DE 9C/payroll requirement.
• Census enrollment available – Accepted for groups with more than five enrolling employees using the MediExcel Excel enrollment template.
• Extended submission deadlines – New group cutoffs extended through the 15th of each month.
• Transition-of-Care support – Prior to the effective date, employees with active treatment plans may schedule Transition-of-Care appointments to help support continuity of care.
• Significant savings opportunity – Salud y Más clients can expect highly competitive MediExcel rates and the potential for substantial premium savings.

Large Group Underwriting Promotion

• Off-cycle renewals accepted – Groups do not need to wait for their current renewal date.
• Short-term contracts available – For groups transitioning to MediExcel ahead of their current renewal.
• Extended contracts available – To align MediExcel with a group’s U.S. carrier renewal date.
• Simplified underwriting documentation – With the most recent Health Net invoice, MediExcel will waive the DE 9C/payroll requirement.
• Census enrollment available – Accepted for groups with more than five enrolling employees using the MediExcel Excel enrollment template.
• Extended submission deadlines – New group cutoffs extended through the 15th of each month.
• Transition-of-Care support – Prior to the effective date, employees with active treatment plans may schedule Transition-of-Care appointments to help support continuity of care.
• Large Group commission enhancement – Up to 7% commission when requested during the underwriting process.
• Large Group communication credits – Available for consideration on a case-by-case basis.
• Significant savings opportunity – Salud y Más clients can expect highly competitive MediExcel rates and the potential for substantial premium savings.

Small Group Underwriting Promotion

• Health Net groups transitioning to Sharp Health Plan may qualify for simplified underwriting for groups with 1+ enrolled subscribers. Eligible effective dates 10/1/2026-3/1/2027.
  • Documentation requirements:
    • A recent, reconciled Health Net invoice may be submitted in place of a DE 9C.
    • If an enrolling employee is not on the invoice, a current pay stub will be accepted.
    • If an enrolling owner is not on the invoice, an SOI will be accepted.
• Sharp Health Plan will allow additional flexibility for Health Net groups that need to transition mid-plan year or coordinate renewal dates with another medical carrier. Early renewal and short contract years will be allowed when the group is currently with Health Net and maintains a dual-carrier medical arrangement and needs to align its Sharp Health Plan renewal date with the other carrier. The group will need to provide a letter requesting the short contract period including the requested renewal date and reason for request. 
• Sharp Health Plan will support continuity of care for members transitioning from Health Net who remain with the same Sharp medical group and providers. For members transitioning to Sharp Health Plan HMO products without a change in medical group, existing authorization that were previously reviewed and approved through HealthNet/Sharp providers will be honored and will not require an additional medical review. 

Bonus

• Bonus is available for new small group subscribers with effective dates of 10/1/2026-3/1/2027.
  • Bonus is based on the total number of new subscribers enrolled from 10/1/2026-3/1/2027.
    • 10-19 subscribers: $75 for each new subscriber enrolled.
    • 20-29 subscribers: $100 for each new subscriber enrolled.
    • 30-39 subscribers: $125 for each new subscriber enrolled.
    • 40-49 subscribers: $150 for each new subscriber enrolled.
    • 50-74 subscribers: $175 for each new subscriber enrolled.
    • 75+ subscribers: $250 for each new subscriber enrolled.
  • The enrolled employee counts will be derived from Small Group HMO/POS medical plan only and will be based on the number of enrolled medical employees as of the group’s effective date. Bonus will be determined based on the number of subscribers who have been active for at least one month during the bonus period. The bonus amount will not be paid if a member disenrolls.
• A “Welcome Back” bonus is available when re-enrolling a small group of any size that left Sharp Health Plan as of 1/1/2020. Bonus is $250 per group. 
• Broker must be Broker of Record on the effective date of the group coverage and at the time the bonus is paid. 
• Payments will be made approximately 120 days after the end of the program period. 
• Medical Incentive Program applies to Small Group HMO/POS Business Off-Exchange sales only (including Off-Exchange Package plans and Mirrored Package plans). Exchange Small Group Business — CaliforniaChoice and Covered California for Small Business (CCSB) — membership is not eligible for this bonus and will not be included to calculate a broker’s eligibility for the bonus.

Small Group Underwriting Promotion

• Extend the monthly enrollment submission deadline from the 10th to the 15th of the month.
• Honor existing Primary Care Physician (PCP) relationships with contracted providers in the Sutter Health Plan network.
• Honor approved and pending prior authorizations for services provided by Sutter Health.
• Apply deductible credits toward applicable medical expenses for eligible members.
• Extend plan agreements to 13 or 14 months for Large Group clients transitioning in November 2026 or December 2026.

Small Group Underwriting Promotion

All agencies can work with a GA on transition business (including agencies that are on the GA exclusion list for UHC Large Group business).  

Bonus

• Bonus for Each Fully Insured and Level-Funded Enrolled Employee: $60
• Bonus for Each  Self-Funded Enrolled Employee: $20