| 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 dependent in the group health plan
- Medicare
- Medi-Cal
- TRICARE
- Indian Health Service (Native American Tribal Coverage)
|
| 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 or spouse of the owner. |
| Owner Only Groups |
Health Net will write Officer Only groups as long as the group’s business entity is specifically a C-Corporation. They will not write Officer Only for any other business entity type.
At least 2 eligible officers are required and at least one of the officers may not be a shareholder, must be listed on the DE9C and must be covered by Worker’s Compensation. |
| Husband & Wife Only Groups |
- Spouses Only groups are not eligible for coverage
- Domestic Partner Only groups are eligible for coverage as long as one of the Domestic Partners is W2 on DE9C/Quarterly Wage Report and not an owner of the group. Confirmation of relationship is required with submission.
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| One-Person Groups |
No information yet |
| Slice Business |
No information yet |
| Employers Replacing Coverage |
No information yet |
| Start-Up Group Requirements |
Requires minimum of 2 weeks payroll prior to the requested effective date An existing group that just hired their first W2 qualifies as a Start-Up. |
| Common Ownership Guidelines |
- Small employers qualified to enroll as a single employer are required to submit a letter from a CPA certifying how they are eligible
- The CPA must not be an owner or employee of the groups seeking coverage
- The letter must be on CPA letterhead and it must explicitly state how the groups are eligible to enroll under a single policy
- Allowable reasons for how common ownership groups are eligible to enroll under a single policy:
- Affiliated companies that are eligible to file a combined tax return for state taxation
- Controlled groups of corporations
- Trades and businesses, whether or not incorporated, under common control
- Affiliated service groups
- Common ownership groups must meet the definition of a small employer when combined
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| Spin-Off Groups |
No information yet |
| Employers with Union Employees |
No information yet |
| Employers Leaving a PEO |
No information yet |