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Participation and Alongside Guidelines

Posted: January 11, 2019 by Staff Writer

Aetna

Participation

60% participation for all group sizes excluding valid waivers (rounded down).

Alongside

Groups offering another carrier’s HMO plan must have at least 40% participation and a minimum of 5 employees enrolling.

Employees covered by the same employer on another group policy are not considered a valid waiver.

 

Anthem BlueCross

Participation

1-4 enrolled employees: 65% participation through 6/15/19 effective dates

5+ enrolled employees: 25% participation through 6/15/19 effective dates

Applies to Medical, Dental and Vision Products

Alongside

Another carrier’s HMO or PPO plans can be sold alongside Anthem as long as Anthem receives the required participation.

Employees who enroll with Kaiser will be considered invalid waivers.

 

Blue Shield of California

Participation

70% participation for mirror plans

65% participation for off exchange plans

25% participation for off exchange plans available to group of 5+ enrolling through 3/31/19.

0% participation for groups selecting Trio only plans with no end date.

Applies to Specialty Products

Alongside

Only one carrier is allowed to be written alongside Blue Shield. Health exchanges are not eligible. The Mirror Package for Small Business cannot be offered alongside another carrier. At least 25% of the total number of eligible employees must enroll with no fewer than 5 enrolled. Blue Shield must be the sole carrier for dental, vision and life plans.

Employees who enroll with Kaiser will be considered invalid waivers.

 

CaliforniaChoice

Participation

1-2 eligible employees:100% participation

3+ eligible employees: 70% participation

Alongside

Wraps are not allowed

 

CalCPA Health

Participation

If the employer is paying 100% contribution, all eligible employees must enroll.

If less than 100% contribution, a minimum of 75% of eligible employees must enroll

Alongside

A firm is eligible to enroll in CalCPA ProtectPlus if 1 employee is joining the program. The rest of the eligible employees may wrap with Kaiser or waive.

 

Health Net

Participation

Enhanced Choice A package: 50% for 6+ eligible employees

Enhanced Choice B package: 35% for 6+ eligible employees

No participation requirement for Salud Network only with minimum of 2 enrolled

HMO Sales Express Underwriting Program: No participation or Participation Attestation Form required with 10+ active enrolling employees. Cal COBRA/COBRA participants do not count towards the minimum 10 enrolled. Groups can only offer HMO networks to be eligible for this promotion

Alongside

Another carrier’s HMO or PPO plans can be sold alongside Health Net as long as Health Net receives the required participation.

Employees who enroll with Kaiser will be considered invalid waivers.

Kaiser Permanente

Participation

50% of eligible employees must be covered by a group plan through 4/1/19 effective dates.

Alongside

A minimum of 1 W2 must enroll with Kaiser Permanente (cannot be an owner or spouse of an owner)

 

MediExcel

Participation

At least 1 eligible employee enrolling regardless of group size

Alongside

Group must have at least one non-owner W2 employee enrolling

 

Oscar

Participation

If employees in all locations is under 100, only the EEs within Oscar’s service area will be counted towards participation (available through 1/15/19).

Alongside

25% of all eligible employees, or a minimum of 5 eligible employees, must enroll with Oscar. Aetna, Blue Shield, CaliforniaChoice, CalCPA, and UHC will not write alongside Oscar.

Sharp Health Plan

Participation

70% participation is required for all group sizes.

Alongside

Group must have 6+ enrolled or 50% of the enrollment with Sharp Health Plan (whichever is greater). Multiple HMO plans allowed – maximum 6 plans / 1 network

Wrap with CaliforniaChoice® is not allowed and PPO product is not available alongside another carrier.

 

SIMNSA

Participation

At least 5 employees enrolling

Alongside

Multiple carries may be offered alongside as long as SIMNSA is the only option across the border.

 

UnitedHealthcare

Participation

60% participation for all group sizes excluding valid waivers.If the employer is paying 100% contribution, all eligible employees must enroll.

Alongside

Choice Simplified Package alongside a staff model carrier: 60% participation between the two carriers with 5 CA employees enrolling with UHC is required.

Multi-Choice® State Package alongside a staff model carrier: 60% participation with UHC is required.




 

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