October 22, 2012

New Underwriting Guidelines for Small Groups

As we informed you in the October Broker Focus, we will be updating our underwriting guidelines on community-rated plans for small groups, including sole proprietors, beginning November 1. Among the major changes are:

  • Participation has been increased to 60 percent
  • Waiver eligibility is being changed so that coverage by another carrier is no longer a
    valid waiver reason
  • Effective November 1, 2012 for new business, groups may choose up to two products in the product suite but need a minimum of five enrolled employees. Groups may choose up to three plans in the EmblemHealth suite provided they have a minimum of 20 enrolled employees.
    Until further notice, renewing and existing groups that already have members enrolled in more than one particular benefit plan type may renew in the same plans.

If you have questions about the new guidelines, please contact your EmblemHealth sales representative.