| 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
- Enrolling as a depending in the group health plan
- Medicare
- Medi-Cal
- TRICARE
|
| 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 |
Cigna+Oscar 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 |
- Start-Up and Virgin groups are eligible (with no DE9C/Quarterly Wage Report).
- 1-2 enrolling: Group must be in business for at least two weeks with two consecutive weeks of payroll
- 3+ enrolling: Payroll is not required
- An existing group that just hired their first W2 qualifies as a Start-Up
|
| Common Ownership Guidelines |
Companies that are affiliated and eligible to file a combined tax return for purposes of state taxation shall be considered one employer.
A letter from the employer’s CPA which states the groups are eligible to file consolidated state tax returns is required.
Common ownership groups must meet the definition of a small employer when combined. |
| Spin-Off Groups |
No information yet |
| Employers with Union Employees |
No information yet |
| Employers Leaving a PEO |
No information yet |