| Criteria |
Information |
| Underwriting Guide |
No information yet |
| Small Group Definition |
No information yet |
| Employer Contribution |
No information yet |
| Carve-Outs / Varied Offerings |
No information yet |
| Participation Requirements |
No information yet |
| NPNC Groups |
No information yet |
| Valid Waivers |
- Spousal Group Coverage
- Medi-Cal
- Parental Group Coverage
- TRICARE
- Enrolling as dependent in the group health plan
- Indian Health Service (Native Individual Coverage American Tribal Coverage)
- Medicare
* Other Group Coverage through Another Employer an employee works for will not be considered a Valid Waiver* |
| Residency Requirements |
No information yet |
| W-2 Enrollment Requirements |
Requires W2 common law employee to enroll. W2 cannot be an owner/officer or spouse/domestic partner of the owner/officer. |
| Owner Only Groups |
Aetna will not write a group without at least 1 non-owner W2 employee. |
| Husband & Wife Only Groups |
Spouses Only/Domestic Partner Only Groups are not eligible for coverage. |
| One-Person Groups |
No information yet |
| Slice Business |
No information yet |
| Employers Replacing Coverage |
No information yet |
| Start-Up Group Requirements |
Requires two weeks of consecutive payroll prior to the requested effective date. An existing group that just hired their first W2 qualifies as a Start-Up. |
| Common Ownership Guidelines |
Groups who have more than one business with different TINs may be eligible to enroll as one group if the following are met:
- One owner has controlling interest of all businesses to be included
- Companies that are affiliated and that are eligible to file a combined income tax return for purposes of state taxation shall be considered one employer
- All groups filed under one combined tax return are considered one group
- There are 100 or fewer employees in the combined groups
- Business with equal controlling interest may be considered if the owners of the company designate an individual to act on behalf of all the groups
- A completed Common Ownership form must be submitted
- Underwriting reserves the right to final underwriting review and may consider common ownership on a case-by-case underwriting exception
All companies in the common ownership group must appear as Active on the California Business Portal |
| Spin-Off Groups |
No information yet |
| Employers with Union Employees |
No information yet |
| Employers Leaving a PEO |
No information yet |