Updates to Group Underwriting Guidelines Available in BlueAccessSM
We continually work to ensure our guidelines and procedures are as streamlined and effective as possible. Updated underwriting guidelines for all group sizes are available in BlueAccess under the Group Broker tab. Please discontinue use of the previous medical, dental and vision guidelines.
Changes to the manuals include:
Small/Intermediate Group Medical Guidelines
- Changed the required tax documentation for new hires of groups with 2-5 enrolling employees. Previously, groups were asked to submit a payroll and an Employee Certification Form for new hires not listed on the current tax and wage documentation. Only the Employee Certification Form will be required for these new hires. A follow-up tax and wage audit will be conducted at a later date to verify eligibility of the new hires.
- Clarified the medical multi-option guidelines regarding the contraceptive-only pharmacy benefit. The contraceptive-only pharmacy benefit is not considered full pharmacy coverage and will be treated as no pharmacy coverage for the purposes of the medical multi-option guidelines. A group may not have one option with regular pharmacy and one option with contraceptive-only pharmacy.
- Relaxed the change in census rate review threshold for intermediate group (26 or more enrolling employees) new sales. If the number of employees who enroll with us is more than 15 percent different (above or below) from the number of quoted participating employees, we reserve the right to review the rates. The previous level was 10 percent.
Small/Intermediate Group Dental/Vision Guidelines
- Clarified that High Deductible Dental Plans are not allowed to be offered in a multi-option combination.
- Changed the required tax documentation for new hires for new sales with 2-5 enrolling employees. Previously, groups were asked to submit a payroll and an Employee Certification Form for new hires not listed on the current tax and wage documentation. Only the Employee Certification Form will be required for these new hires. A follow-up tax and wage audit will be conducted at a later date to verify eligibility of new hires.
Large Group Medical Guidelines
- Clarified the medical multi-option guidelines regarding the contraceptive-only pharmacy benefit. The contraceptive-only pharmacy benefit is not considered full pharmacy coverage and will be treated as no pharmacy coverage for the purposes of the medical multi-option guidelines. A group may not have one option with regular pharmacy and one option with contraceptive-only pharmacy.
Large Group Dental/Vision Guidelines
- Clarified that High Deductible Dental Plans are not allowed to be offered in a multi-option combination.
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