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Large Group Business Health Insurance

Employers with 51+ employees enrolling in a business health insurance plan are considered to be in the large group (or middle market) segment. Large group business health insurance plans, unlike small group business health insurance plans, are not ‘guarantee issue,’ meaning insurance companies can decline to quote a large employer business group health insurance coverage.

Reasons an insurance company will decline to quote a large employer business health plan are:

  • Poor medical or claims histories within the group of employee and dependents.
  • A history of the employer changing health insurance carriers many times in the most recent five years.
  • If a health insurance company believes it cannot be competitive with an employer’s current business health insurance plan.
  • A large ratio of COBRA participants enrolled on the current employer’s business health insurance plan (COBRA participants generally remain attached to a group health plan and, due to pre-existing medical conditions, participants remaining on COBRA can cause higher utilization of benefits or losses for the employer group).
  • Not enough employees enrolled in the plan to make it profitable and worthwhile to the health insurance company

Large business health insurance plans (51+ employees) are often quoted and underwritten differently than small business health insurance plans (2 to 50 employees).

General Request for Proposal (RFP) information collected from an employer for a large business health insurance quote is as follows:

  • If a current business health insurance plan is in place, a copy of the current rates and benefits are required by the health insurance company providing the quotes.
  • Information supplied regarding the employers level of contributions made toward the current coverage, if domestic partners are covered, as well as other details are collected.
  • A ‘gatekeeper’ questionnaire supplying general information about the business, normally completed by the Human Resources contact of the employer.
  • A completed employee census providing details on active employees, dependents, and COBRA participants to be covered by the proposed new business health insurance plan.

With the information supplied by the employer, health insurance company underwriters will determine if they believe they can be competitive with the current in-force business health insurance plan, as well as assess the risk to make sure it is a desirable and profitable piece of business from the health insurance company’s standpoint. If the health insurance company provides a quote, then it is generally an offer to cover the group at the prices and benefits provided assuming the details supplied don’t change in a significant manner.

Federal law mandates that group health insurance plans be renewed at the employer’s option, unless there is cause, such as non-payment of premium, fraud, misrepresentation, or if the group falls out of compliance.

To learn more about large group business health insurance options please call a representative now to discuss your situation and have the Request for Proposal information sent to you, or email us through this link.

 

 

 

 

 
800-858-5555