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Quote your client as a Small or Large Employer (Read First)

The medical carriers no longer count how many employees are eligible for the benefits, nor do they count how many enroll in the medical plan when deciding how a group should be rated.

Instead, the carriers use the group's Total Average Employee (TAE) count to determine whether a group is rated as a small employer (2-99) or a large employer (99+). Any Pennsylvania group that has employed, on average, 51 or more employees during the preceding calendar year will be considered a large employer for the purposes of rating.

The ACA defines an employee as any person for whom the company issues a W-2, and this includes full-time, part-time and seasonal workers who may or may not have been eligible for the employer's medical plan. This does not include 1099 independent contractors.

If you are uncertain as to how your client should be rated, have them complete the Employee Count Form provided below.

Employee Count Form (excel)

Employee Count Form (PDF)

 

Small Employer (2-50 TAE)

Due to the changes from the Affordable Care Act, you will now need to provide a member level census containing the demographics of ALL enrolling subscribers and dependents in order to obtain health insurance proposals for your clients. 

In addition, you will also need to capture "tobacco / non-tobacco" on the census. 

Previously - "Employee Level" Census
 
John Smith
04/10/1968
M
Family
15222
 

Effective Now - "Member Level" Census
Employee
John Smith
04/10/1968
M
Family
15222
Tobacco
Spouse
Jane Smith
07/25/1969
F
 
15222
Non-Tobacco
Dependent
Matt Smith
10/25/1998
M
 
15222
Non-Tobacco
Dependent
Mary Smith
08/17/2005
F
 
15222
Non-Tobacco

We've modified our Group Quote Request Form to assist you with capturing the proper data. Both Excel and PDF versions are available for download by following the links below.

Please note, while both versions are acceptable; the excel file is recommended. Due to the increased volume associated with the now larger censuses, our standard turnaround times could be impacted when submitting a hand-written, PDF version. 

2017 Group Quote Request Form
 (excel)  (Revised August 2017)

2017 Group Quote Request Form (PDF)  (Revised August 2017)

Large Employer (51+ TAE)

Aetna

 

If group has 100+ enrolled, the following information must also be provided:

 

  • Employee-Level Census
  • Claims Information
    • Month-by-month claims and enrollment by plan for the most recent 12 month period
    • Large claim report / shock claims
    • Incumbent carrier renewal calculation

Highmark

 

If group has 100+ enrolled, the following information must also be provided:

 

  • Claims Information
    • Month-by-month claims and enrollment by plan for the most recent 12 month period
    • Large claim report / shock claims
    • Incumbent carrier renewal calculation

 

United Healthcare

  • Employer Application
  • Member-Level Census 
  • Current Rates & Renewal Offer
  • Benefit Grid(s)
    • If group currently has an HRA, provide the funding arrangement


In order to quote fully insured business with 51-350 eligible employees, the following information must also be provided:

  • Member-Level Data (Employee and dependents)
    • First Name
    • Last Name
    • Date of Birth
    • Home Zip Code

 

If group has 100+ enrolled, the following information must also be provided:

 

  • Claims Information
    • Month-by-month claims and enrollment by plan for the most recent 12 month period
    • Large claim report / shock claims
    • Incumbent carrier renewal calculation

UPMC

 

If group has 100+ enrolled, the following information must also be provided:

 

  • Claims Information
    • Month-by-month claims and enrollment by plan for the most recent 12 month period
    • Large claim report / shock claims
    • Incumbent carrier renewal calculation