CA Small Group Pre-existing Condition

[Franz Kafka]

Got a call today. A husband and a wife own a small business with all the necessary documentations. Husband was just diagnosed with skin lymphoma. Could they skill get a small group coverage? (I know the state law says they can) Anthem underwriting guides states that a HMO plan doesn't require waiting period for pre-existing. If they can get the coverage and the husband begins treatment, what's the maximum rate increase they can expect come next enrollment? Also will I be black-listed by the carrier for writing this case? TIA.

 

[Dave020]

Got a call today. A husband and a wife own a small business with all the necessary documentations. Husband was just diagnosed with skin lymphoma. Could they skill get a small group coverage? (I know the state law says they can)

Yes, so long as they meet AB 1672 qualification guidelines and have been properly set up at least 1/2 of the previous calendar quarter (August 15 for current start dates, Nov 15th for 1/1/10 and after start dates)

Anthem underwriting guides states that a HMO plan doesn't require waiting period for pre-existing. If they can get the coverage and the husband begins treatment, what's the maximum rate increase they can expect come next enrollment?

1.10 RAF, 10% above standard premium maximum. That is what they will get so quote that. No spousal gets less than 1.10 RAF unless they buy life insurance, then they get 1.09.

They cannot be singled out for any rate increase so it will simply follow the age and rating area changes for the entire group. Make the younger spouse the primary. If they don't have kids, separate them into 2 employees. If kids are going on the plan, make it a family plan with younger spouse as primary. The reason you want to separate them if no kids is because the rate for the dependent is usually double that of the employee (actuaries at work).

Rate increase depends on the plan they are on. Lumenos have been hit the hardest in the last couple of years (HSA). Hard to say I believe there is a rate focal for January 1 buy I have not looked at it yet.

Also will I be black-listed by the carrier for writing this case? TIA.

Yes, the will send a couple of guys called "Bruno and Max" to break your legs No, they really don't care about this kind of thing.

 

[Franz Kafka]

Dave to the rescue as always!

I just called them and confirmed that they could be covered. They are very happy and appreciative.

Thanks Dave!