NEWSROOM

Start-up Groups

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Aetna

Requirements

Groups with 1-19 enrolled employees and groups with no existing health coverage must submit a copy of the
most recently filed DE9C. If not available, two consecutive weeks of payroll records are required

An existing group that has just hired their first W2 qualifies as a start-up with two weeks of consecutive payroll

 

Anthem BlueCross

Requirements

A signed and completed Conditions of Enrollment form is required

The company's first 30 days of payroll records must be submitted within the first 45 days of the requested effective date

Business Documentation required (example: business license/SOI)

An existing group that has just hired their first W2 qualifies as a start-up, including Sole Proprietors and Partnerships

 

Blue Shield of California

Requirements

Blue Shield will consider Start-Up groups that have been in business and have employed at least one eligible
common law W2 employee for less than 6 weeks

The W2 employee can be hired on the requested effective date. In this scenario Blue Shield will not accept the
group before the date of hire

A signed and completed Start-Up Companies/Spin-Off Group Eligibility Statement will be required

W4 forms for all W2 employees are required

Filed owner documentation linking owner to business is required

Groups Offering Coverage to Part Time Employees: Newly hired Part Time employees are not eligible for coverage until they meet the 50% of the prior calendar quarter rule in any group scenario

 

CaliforniaChoice

Requirements

1-4 Enrolling: At least one common law employee must enroll and have 4 weeks of payroll prior to the requested effective date. The other common law employees are required to be on payroll for at least one week on or prior to the effective date (or from start date to current, whichever is greater)
If the owner is not on payroll, provide ownership documents

5+ Enrolling Where Majority Enrolling are Common Law Employees: One week of payroll is required for a contingent approval. The remaining payroll to complete one month is contingent.
If the owner is not on payroll, provide the Owner/Partner form. Ownership documents may be requested at the underwriter’s discretion

5+ Enrolling Where Majority Enrolling are Owners: 1 common law employee must be on payroll for 4 weeks prior to the requested effective date
If the owners are not on payroll, provide the Owner/Partner forms and applicable owner documents

Health Net

Requirements

Groups of 1-5 eligible employees are not eligible for Start-Up. They must be in business for 50% of the prior
calendar quarter

6+ enrolling: Requires 4 weeks of payroll with a minimum of 2 weeks prior to the effective date

 

Kaiser Permanente

Sole Props & Partnerships:

Minimum 1 eligible W2 employee, on or before requested effective date and unable to provide 2 weeks of payroll

Group must provide Payroll Attestation form at enrollment and follow with 2 weeks of payroll within 45 days of effective date

Owners/Partners and their Spouses/Domestic Partners do not count as the eligible employee

Corporations & LLCs:

Minimum 1 eligible W2 employee, on or before requested effective date and unable to provide 2 weeks of payroll

Group must provide Payroll Attestation form at enrollment and follow with 2 weeks of payroll within 45 days of effective date

A single owner may count as the eligible W2 employee who will appear on payroll with eligible wages

 

UnitedHealthcare

Requirements

Group must be in business 6 weeks prior to the requested effective date and provide at least 2 weeks of
payroll

Evidence of time in business must be supported by payroll records. The payroll records must cover the 2
weeks preceding the requested effective date for at least one eligible employee

The group must have and maintain business licenses and/or appropriate state filings allowing the company to
conduct business in the state of California

Owner Only Start-up Groups are not eligible

All groups must be true start-ups. An existing group that has just hired their first W2 is not eligible

Start-Up Groups

This guide has been created as a quick reference and does not replace the full underwriting guidelines published by each carrier
Please refer to the carrier guidelines for additional information


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