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Start-up Groups

Posted: July 10, 2019 by Staff Writer

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

1-4 enrolling: Start-up group must have been in business for a minimum of at least 4 weeks. Payroll records must cover the 4 weeks preceding the requested effective date for at least 1 eligible employee

5+ enrolling: Start-up groups that have been in business for less than 4 weeks are eligible if the business has been operating for at least one pay period. Evidence of time in business and eligibility must be supported by payroll records

CaliforniaChoice

Requirements

1-4 enrolling: At least one common law employee must enroll and have 6 weeks of payroll. 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: 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

CalCPA Health

Requirements

Groups established less than 90 days before the effective date will need to submit at least 30 days of payroll records

Health Net

Requirements

Groups with 1-5 eligible employees are not eligible

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

Kaiser Permanente

Start-up groups require a minimum of 6 weeks of payroll.

Promotion:

4 weeks of payroll through 1/1/20

Sharp Health Plan

Requirements

Start-up groups require a minimum of 6 weeks of payroll

UnitedHealthcare

Requirements

Start-up groups that have been in business for at least 2 weeks are eligible

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 that has just hired their first W2 is not eligible




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