Special Annual Open Enrollment

There is an Special Open Enrollment Period from 11.15 to 12.15 every year where a Small Group can enroll without meeting participation or contribution requirements. “Final Rule” (2.27.2013 13416 Federal Register Vol 78 gpo.gov

The  Prohibition of  Management Carve Out Section 2716 Health Care Reform – while not presently enforced, requires that you must treat all employees the same,  and must still offer insurance to all employees…  I don’t think this provision is that big a deal, as at renewal, you MUST meet the participation & contribution rules!

Although carriers must lower their contribution requirements, the Affordable Care Act still mandates that Applicable Large Employers (ALEs) with 50 or more full-time plus full-time equivalent employees must offer affordable coverage that meets minimum value in order to avoid a §4980H(b) employer penalty.

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Insurance Carriers Rules & deadlines 

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Health Plan

Special Open Enrollment Guidelines

Aetna

  • Must be the sole carrier confirmed by an attestation form
  • Groups must be complete at submission with all requirements in by 12/15. No exceptions for missing items
  • Recertification at renewal: Yes, to ensure group meets the definition of a small employer
Blue Cross – Anthem

  • Must be the sole carrier
  • Groups must be complete at submission with all requirements in by 12/15. No exceptions for missing items
  • Recertification at renewal: No; Special Open Enrollment Window groups will not be targeted for a participation audit, however they could be recertified at random
Blue Shield

Blue Shield Info through 3.31.2016

  • Does not require to be the sole carrier
  • Case must be approved within 30 days of submission or it will be withdrawn
  • Recertification at renewal: Yes, groups will need to meet minimum participation requirements upon renewal
California Choice – A Private Exchange

  • Must be the sole carrier
  • Case must be approved by: 12/31
  • Contingent approvals will not be allowed
  • Recertification at renewal: carrier discretion
Health Net

  • Does not require to be the sole carrier
  • Cases must be received by Health Net by 5:00 pm on 12/15
  • Case must be approved by: 1/20
  • Recertification at renewal: carrier discretion
Kaiser Permanente – New Enrollment

Kaiser – Very General Info

 
United Health Plan

  • Does not require to be the sole carrier with staff model carrier. UHC requires at least 5 CA employees to enroll with UHC
  • Groups must be complete at submission with all requirements in by 12/15. No exceptions for missing items
  • Recertification at renewal: Yes, all groups are subject to recertification annually
Sharp Health Pla
  • Must be the sole carrier. Sharp will write alongside a cross border plan. Cross border plans are considered valid waivers.
  • Case must be approved by: 12/15, no exceptions
  • Recertification at renewal: carrier discretion
SHOP – Covered CA for Small Business  
Warner Pacific – Requires Log In  

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