A local General Agent sent the following information out in a newsletter. Please keep in mind this is for AZ business.
The Affordable Care Act has brought significant changes to employer groups in 2014. One area impacted by the ACA is eligibility and participation for husband/wife employer groups, where the husband and wife are each enrolled separately as “employee only”. Some of our major medical carriers have provided the following guidelines on whether these types of groups will be allowed or not:
AETNA: As of today, Aetna is allowing husband/wife groups to renew, but underwriting is giving until their next renewal in 2015 to meet the W-2 requirements (must have at least one other full-time eligible employee, W-2 or other, reflected to be eligible for the small group coverage). Aetna will send a formal notice explaining the requirements. If the group cannot meet the requirement by their 2015 renewal they will be terminated.
BCBSAZ: As of today, until further notice, it is “business as usual”. A husband/wife group can still be offered insurance, (or 2014 renewal) as long as there are 2 eligible, both working full time.
HEALTH NET AZ: For existing groups upon 2014 renewal, Health Net does not have a means of establishing which groups are husband/wife, and therefore not imposing a renewal eligibility requirement. However, they will not accept new business husband/wife groups or allow a renewal to establish a new husband/wife eligibility class.
HUMANA: There must be a wage earner documented on a wage & tax in order to verify employer/employee relationship. If a wage and tax statement is not filed, the group is not eligible for coverage. 2014 and later effective dates, a husband and wife may enroll as employee and spouse, or family coverage, regardless of other employees. The group may be reviewed for eligibility at any
time. When the group is reviewed, most often at renewal, they are given a time period in their notice to become compliant with eligibility requirements. If the group is unable to become compliant in that time, the coverage would be terminated.
UHC: UHC is no longer allowing groups to renew in 2014 as husband/wife that are enrolled as “employee only”. Per UHC, some states are offering transitional relief for one year, but Arizona is not a participating state. The only way a current husband/wife group targeted for participation can renew their group coverage is to have at least one other full-time eligible employee (W-2 or other)
reflected to be eligible for the small group coverage. The 3rd employee does not have to be enrolled, but must be reflected. If the group cannot meet this requirement, the coverage would be terminated.
Please keep the above in mind when reviewing your employer groups upon their renewals in 2014, to ensure they meet requirements and can continue coverage.
AETNA: As of today, Aetna is allowing husband/wife groups to renew, but underwriting is giving until their next renewal in 2015 to meet the W-2 requirements (must have at least one other full-time eligible employee, W-2 or other, reflected to be eligible for the small group coverage). Aetna will send a formal notice explaining the requirements. If the group cannot meet the requirement by their 2015 renewal they will be terminated.
BCBSAZ: As of today, until further notice, it is “business as usual”. A husband/wife group can still be offered insurance, (or 2014 renewal) as long as there are 2 eligible, both working full time.
HEALTH NET AZ: For existing groups upon 2014 renewal, Health Net does not have a means of establishing which groups are husband/wife, and therefore not imposing a renewal eligibility requirement. However, they will not accept new business husband/wife groups or allow a renewal to establish a new husband/wife eligibility class.
HUMANA: There must be a wage earner documented on a wage & tax in order to verify employer/employee relationship. If a wage and tax statement is not filed, the group is not eligible for coverage. 2014 and later effective dates, a husband and wife may enroll as employee and spouse, or family coverage, regardless of other employees. The group may be reviewed for eligibility at any
time. When the group is reviewed, most often at renewal, they are given a time period in their notice to become compliant with eligibility requirements. If the group is unable to become compliant in that time, the coverage would be terminated.
UHC: UHC is no longer allowing groups to renew in 2014 as husband/wife that are enrolled as “employee only”. Per UHC, some states are offering transitional relief for one year, but Arizona is not a participating state. The only way a current husband/wife group targeted for participation can renew their group coverage is to have at least one other full-time eligible employee (W-2 or other)
reflected to be eligible for the small group coverage. The 3rd employee does not have to be enrolled, but must be reflected. If the group cannot meet this requirement, the coverage would be terminated.
Please keep the above in mind when reviewing your employer groups upon their renewals in 2014, to ensure they meet requirements and can continue coverage.
