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
