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Start-up Groups

Posted: June 10, 2020 by Staff Writer

Aetna

Requirements

Groups with 1-19 enrolled employees and groups with no existing health coverage must submit a copy of the most recently filed DE9C. If not available, two consecutive weeks of payroll records are required

An existing group that has just hired their first W2 qualifies as a start-up with two weeks of consecutive payroll

Anthem BlueCross

Requirements

A signed and completed Conditions of Enrollment form is required

The company’s first 30 days of payroll records must be submitted within the first 45 days of the requested effective date

Business Documentation required (example: business license/SOI)

An existing group that has just hired their first W2 qualifies as a start-up, including Sole Proprietors and Partnerships

Blue Shield of California

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

A signed and completed Start-Up Companies/Spin-Off Group Eligibility Statement will be required

W4 forms for all W2 employees are required

Filed owner documentation linking owner to business is required

CaliforniaChoice

Requirements

1-4 enrolling: At least one common law employee must enroll and have 6 weeks of payroll. The other common law employees are required to be on payroll for at least one week on or prior to the effective date (or from start date to current, whichever is greater)

If the owner is not on payroll, provide ownership documents

5+ enrolling: One week of payroll is required for a contingent approval. The remaining payroll to complete one month is contingent

If the owner is not on payroll, provide the Owner/Partner form. Ownership documents may be requested at the Underwriter’s discretion

Health Net

Requirements

Groups with 1-5 eligible employees are not eligible

6+ enrolling: Requires 4 weeks of payroll with a minimum of 2 weeks prior to the effective date

Kaiser Permanente

Sole Props & Partnerships:

Minimum 1 eligible W2 employee, on or before requested effective date and unable to provide 2 weeks of payroll

Group must provide Payroll Attestation form at enrollment and follow with 2 weeks of payroll within 45 days of effective date

Owners/Partners and their Spouses/Domestic Partners do not count as the eligible employee

Corporations & LLCs:

Minimum 1 eligible W2 employee, on or before requested effective date and unable to provide 2 weeks of payroll

Group must provide Payroll Attestation form at enrollment and follow with 2 weeks of payroll within 45 days of effective date

A single owner may count as the eligible W2 employee who will appear on payroll with eligible wages

UnitedHealthcare

Requirements

Start-up groups that have been in business for at least 2 weeks are eligible

Evidence of time in business must be supported by payroll records. The payroll records must cover the 2 weeks preceding the requested effective date for at least one eligible employee

The group must have and maintain business licenses and/or appropriate state filings allowing the company to conduct business in the state of California

Owner Only Start-up Groups are not eligible

All groups must be true start-ups. An existing group that has just hired their first W2 is not eligible

This guide has been created as a quick reference and does not replace the full underwriting guidelines published by each carrier
Please refer to the carrier guidelines for additional information

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