General Information
| Criteria |
Information |
| Carrier size |
No information yet |
| Carrier info |
No information yet |
| Ownership / Sister Companies |
No information yet |
| Appointment Info |
No information yet |
| General Agent |
No information yet |
Service Area and Network
| Criteria |
Information |
| Service Area |
No information yet |
| PPO Network |
No information yet |
| HMO Network |
No information yet |
| Provider Search |
No information yet |
| Formulary |
No information yet |
Plans and Rates
| Criteria |
Information |
| Overview |
No information yet |
| PPO Plan Options |
No information yet |
| HMO Plan Options |
No information yet |
| Multiple Plan Offerings |
No information yet |
| Composite and Age Rating |
No information yet |
| Formulary |
No information yet |
Underwriting Guidelines
| 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 |
- Other Group Coverage
- Individual Coverage
- Medicare
- Medi-Cal
|
| Residency Requirements |
No information yet |
| W-2 Enrollment Requirements |
W2 common law employee may waive as long as group meets all participation requirements. W2 cannot be an owner/officer. |
| Owner Only Groups |
Blue Shield will not write a group without at least 1 non-owner W2 employee. |
| Husband & Wife Only Groups |
Blue Shield will accept Spouses Only/Domestic Partner Only Groups as long as both are not owners One of the spouses/domestic partners must be a W2 employee on payroll and not an owner.
The group cannot be a Sole Proprietor or Partnership Group, must be an S-Corporation, C-Corporation or an LLC. |
| One-Person Groups |
No information yet |
| Slice Business |
No information yet |
| Employers Replacing Coverage |
No information yet |
| Start-Up Group Requirements |
Blue Shield will consider Start-Up groups that have been in business and have employed at least one eligible common law W2 employee for less than 6 weeks. The W2 employee can be hired on the requested effective date. In this scenario Blue Shield will not accept the group before the date of hire. |
| Common Ownership Guidelines |
Copies of Articles of Incorporation/Partnership Agreements are required for each group Common ownership groups must meet the definition of a small employer when combined. 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 |
Employee Eligibility
| Criteria |
Information |
| Full-Time Status |
No information yet |
| Part-Time Eligibility |
No information yet |
| New-Hire Waiting Period |
- First of the month following date of hire
- First of the month following 30 days from the date of hire
- First of the month following 60 days from the date of hire
- On the 91st day following the date of hire
|
| 1099 Workers |
No information yet |
| Owner Eligibility |
No information yet |
| Spouses working for same company |
No information yet |
| Domestic Partners |
No information yet |
| Ineligible Employees |
No information yet |
Enrollment Paperwork and Documentation
| Criteria |
Information |
| Enrollment Checklist |
No information yet |
| Employer App |
No information yet |
| Employee App |
No information yet |
| Enrollment Spreadsheet |
No information yet |
| Wage & Tax Statement |
DE9C/Quarterly Wage Report not required for groups of 3-95 FT/FTE that have 3-95 eligible employees Owners do not qualify towards the eligible FT/FTE employee count
No DE9C/Quarterly Wage report guideline does not apply to PEO, Union/Non Union, Start-Up, Spin Off and Multiple Employer groups
DE9C/Quarterly Wage Report will be required regardless of group size for the following:
- Groups with eligible employees who are 70+ years old
- Groups with 2+ enrolling employees residing at the same address
- Groups with “Other” as their Legal Entity Type
- Groups of 1 enrolling
Underwriting reserves the right to request DE9C/Quarterly Wage Report and/or Payroll whenever necessary to determine eligibility
Blue Shield may require the most recent Companywide Payroll Journal Report for groups with eligible Out of State employees to confirm 51% of all eligible employees reside in California |
| Other Forms/Documentation |
No information yet |
| Initial Payment |
No information yet |
| Effective Date Options |
No information yet |
More Info Coming Soon
Small Business Library: https://www.blueshieldca.com/bsca/bsc/wcm/connect/broker/broker_content_unauth_en/small-business/resources/smallbusinesslibrary