Important Updates for Anthem Blue Cross Small Group Underwriting Guidelines

As the dynamics of the Small Group Insurance Market in California continue to evolve, Anthem CA is making the following changes in support of a more flexible underwriting model.

These changes are effective immediately:

An Anthem “Attestation” form will be accepted in lieu of a prior carrier bill, when:

  • The group has 25 or more enrolled, and
  • The group is coming out one of the below types of large or multiple employer group scenarios:
    1.  Association plan
    2.  Trust plan
    3.  Non-renewed in large group due to a company size reduction
    4.  Spin off from a large employer group. 

PEO sub/hybrid groups are now eligible to enroll with Anthem Blue Cross:

Groups currently with a PEO (Professional Employer Organization) that choose to remain in the PEO for various services, must meet the following criteria:
  • The PEO sub-group must qualify and enroll on a stand-alone basis, separate from the PEO. 
  • Employees of the PEO are not eligible to enroll in the sub-group. Employees of the PEO could be defined as follows: 
    • An employee working in service and conducting business on behalf of the PEO entity itself (i.e., an employee of ADP Total Source, Emplicity, TriNet, Paychex, etc.). – Not eligible
    • A leased employee – Not eligible
    • An employee of a co-employment arrangement – Eligible
  • The principal business address of the sub-group must be in California and indicated as such on the Employer application.
  • General Agreements, Section K of the Employer Application must be signed by an authorized representative of the sub-group, not the PEO. 
  • COBRA provisions are determined by the sub-group’s size only.
  • A PEO sub-group letter/attestation must be included with the new group submission paperwork.
  • In lieu of a DE9C, the sub- group may submit either payroll records for the most current 3-month period; including the following: sub-group company name, employee names, social security numbers, wages, withholdings, and summary totals; or a copy of most recent PEO invoice including the same information (sub-group company name, employee names, social security numbers, wages, withholdings, and summary totals).
Source: Anthem Blue Cross