1-100 Small Group Underwriting Guidelines - Anthem

General underwriting guidelines for Small Group businessIneligible for group coverage:Group eligibility requirements— Owner only - owners on their own or with theirspouse/domestic partners, officers or partners.An employer that meets the employer eligibilityrequirements under the ACA and under the California SmallGroup regulations is eligible for guarantee issue andguaranteed renewal under a small group health plan.}— Employer groups with less than 51% of employeesworking in CaliforniaA group must be a person, firm, proprietary or nonprofitcorporation, partnership, public agency or GuaranteedAssociation. The employer must be actively engaged inbusiness or service.}A group must have and maintain business licensureand/or appropriate state filings allowing the companyto conduct business in California.}A group must not have been formed primarily for thepurpose of obtaining health insurance.}A group must involve a bona fide employer-employeerelationship.— Seasonal, temporary, and substitute employees,defined as employees hire with a planned futuretermination date— Contract employees (1099), employees compensatedon a 1099 basis— Sole proprietors, spouses of sole proprietors,partners of a partnership and the spouses ofthose partners— Employees that do not reside within the 48contiguous states, Alaska, Puerto Rico, or UnitedStates Virgin IslandsA group wanting to re-apply for Anthem may be ineligible ifthey have not complied with prior requirements. Categoriesinclude, but are not limited to:}Canceled for non-pay}Termination for recertification non-compliance.To be considered for coverage all prior cases must be ingood standing, all requirements complete.An individual who wholly owns the company on his/her ownor with his/her spouse/domestic partner, the spouses ofsole proprietors, partners of a partnership and their spouses,a 2% S corporation shareholder, a worker described inSection 3508 of Title 26, Internal Revenue Code, or a leasedemployee (as defined in 26 U.S.C. § 414(n)(2)) does not qualifyas an employee for purposes of group eligibility.Employee eligibility requirementsAggregation rules -- All employers treated as a singleemployer under section 414(b), (c), (m) or (o) of theInternal Revenue Service Code are treated as a singleemployer for purposes of determining group size.Therefore, all employees of a controlled group ofentities under section 414(b) or (c), an affiliated servicegroup under section 414(m), or an entity in anarrangement described under section 414(o), are takeninto account in determining whether the members ofthe controlled group or affiliated service group togetherare an applicable large employer.Affiliated companies — Under common control arerequired to enroll separately unless they are eligible tofile a combined tax return for the purposes of statetaxation. In determining group size, affiliated companieseligible to file a combined tax return for purposes ofstate taxation are considered one employer even if theyare not presently filing together.}Permanent employees who are actively engaged ona full-time basis in the conduct of the business of thesmall employer, with a normal work week of anaverage of 30 hours per week over the course of amonth, at the small employer’s regular place ofbusiness, who have met any statutorily authorizedapplicable waiting-period requirements.}Sole proprietors or partners of a partnership, if they areactively engaged on a full-time basis (average of 30 hoursper week over the course of a month) in the employer’ssmall business and included as employees under ahealth care service plan contract of a small employer.}Permanent employees who work at least 20 hours, butnot more than 29 hours, are deemed to be eligibleemployees if all four of the following apply:— The employee otherwise meets the definition ofan eligible employee except for the number ofhours worked.— The employer offers the employees health coverageunder a health benefit plan.4Section 2For plan years beginning on or after January 1, 2016, asmall employer is defined as an employer employing anaverage of at least one, but no more than 100 full-time,including full-time equivalent, employees during thepreceding calendar year and who employs at least oneemployee on the first day of the plan year. For purposesof determining employer eligibility in the smallemployer market, California adopted the federalmethod for counting full-time employees and full-timeequivalent employees (SB 125, 2015).}}— Carve out groups

General underwriting guidelines for Small Group business— All similarly situated individuals are offeredcoverage under the health benefit plan.Section 2— The employee worked at least 20 hours per normalworkweek for at least 50% of the weeks in theprevious calendar quarter. The health care serviceplan may request any necessary information todocument the hours and time period in question,including, but not limited to, payroll records andemployee wage and tax filings.— Please see page 8 for additional life anddisability guidelines.}an employer group, to get group coverage from aHawaii–authorized insurer. This would ensure thatall the state requirements are met.ContributionEmployers may choose their preferred approach forcontributing to employee medical premiums. Payrolldeduction is required, if contributory. Employers havethe following contribution options:MedicalEmployees must reside within the 48 contiguousstates, Alaska, Puerto Rico or United StatesVirgin Islands.Note: Owners may demonstrate that they meetthe eligible employee criteria by providing W-2sor completing an Eligibility Statement.Enrolling rehired employeesIf an enrollee’s employment ends and the employee islater rehired, certain restrictions apply. If the employeeis rehired within 31 days of termination, coverage willresume with no lapse upon our receipt of a writtenrequest from the employer group.If the employee is rehired more than 31 days fromtermination but not more than 91 days, coverage shallrestart effective on the rehire date. The rehiredemployee will not be subject to applicable groupimposed waiting periods and must complete a newEmployee Enrollment Application.If the employee is rehired more than 91 days (13 weeks)after the termination date, the employee is considereda new employee, subject to applicable group-imposedwaiting periods and must complete a new EmployeeEnrollment Application. The group is responsible fornotifying us immediately if an employee is rehired andwill be continuing coverage.Residents of HawaiiHAWAII ALERT — Because Anthem is neither aHawaii–authorized insurer nor a Hawaii HealthCare Contractor, our benefits may not match therequirements of the Prepaid Health Care Act. Werecommend that you get direct quotes for eitheran individual policy for employees who live and workin Hawaii, or if there are several employees within5}Traditional — A minimum contribution of50% of each employee’s monthly health premium}Fixed-dollar — Any fixed-dollar amount 100 orgreater (in 5 increments) for each coveredemployee’s health premium}Percentage and plan — A minimum of 50% toward aspecific plan, chosen by the employerNote: During the annual open enrollment period ofNovember 15 to December 15, contributionrequirements will not be enforced. The effective datewill be January 1 of the following year.Life}Basic life: Minimum employer contribution (notincluding dependent coverage) is 25% forcontributory plans and 100% for noncontributoryplans. Payroll deduction is required, if contributory.}Optional life: 100% employee-paid. Payroll deductionis required.}Voluntary life: 100% employee-paid. Payrolldeduction is required.Disability}Short-term disability: Minimum employercontribution (not including dependent coverage)is 25% for contributory plans and 100% fornoncontributory plans. Payroll deduction isrequired, if contributory.}Voluntary short-term disability: 100%employee-paid. Payroll deduction is required.}Long-term disability: Minimum employercontribution (not including dependent coverage)is 25% for contributory plans and 100% fornoncontributory plans. Payroll deduction isrequired, if contributory.}Voluntary long-term disability: 100% employee-paid.Payroll deduction is required.

The metal structure represents actuarial values (AVs) andcan be used to compare how overall cost sharing differsacross plans. Minimum and maximum AVs for each type ofplan include:Medical plan participationThe group participation requirements are:— 70% — groups with 1-14 eligible employees— 50% — groups with 15 or moreeligible employees— Platinum 88%/92%— Minimum participation is 100%,if noncontributory— Silver 68%/72%— Gold 78%/82%— Bronze 58%/62%Anthem may conduct periodic audits to confirmparticipation levels.Product typesNote: During the annual open enrollment period ofNovember 15 to December 15, participation requirementswill not be enforced. The effecti

1-100 Small Group Underwriting guidelines Designed for agents and producers Effective January 2020. 2 Important contact information Small Group Underwriting address Anthem P.O. Box 9042 Oxnard, CA 93031-9042 Small Group Underwriting New business: newsguwca@anthem.com