News

New Anthem Blue Cross Small Group RAF Program, Effective 10/1

26 August 2011

Anthem Blue Cross would like to inform you of their refreshed RAF program, effective October 1, 2011.

RAF Program Details
Beginning with October 1, 2011 effective dates:

Number of Enrolling Medical Subscribers per Group RAF Guarantee
1–5 1.10
No health questionnaires required.
6–9 .95
10+ .90
10+ enrollees with more than 70% enrolled in Solution and/or Elements Hospital plans .95

RAF Promotion Guidelines:
 

This promotion is only applicable to the EmployeeElect portfolio.

Groups must apply for the RAF promotion prior to final underwriting approval.

Groups must be AB 1672-eligible, and they submit a copy of their original renewal with an RAF of 1.06 or lower.* Please note that companies with prior dual coverage are eligible, provided that both original renewals indicate an RAF of 1.06 or lower.

Groups of less than 10 enrollees and with no prior medical coverage are not eligible for this promotion. However, they may still apply for coverage through standard underwriting practices, and the appropriate RAF will be applied.

Groups of less than six enrollees and with prior medical coverage may apply for RAF of less than 1.10, but will be subject to full underwriting (completed health questionnaires for all enrollees).*,**

COBRA/Cal-COBRA enrollees do not count toward enrolled employee counts.

PEO spin-off groups:

Anthem will consider companies that have terminated their PEO contract and assumed sole responsibility as the employer of record, but there are
certain requirements, including:

Groups are subject to normal new business underwriting requirements, including but not limited to, business owner documentation and/or applicable tax forms, prior carrier bill, etc.

Groups must have maintained 2–50 worksite employees for 50% of the previous calendar quarter or 50% of the previous calendar year.

In the event a DE-6 or payroll is unavailable at the time of submission, groups must provide the following:

A copy of the PEO client invoice billed to the worksite business, which includes the names of each employee previously leased to the worksite employer, and

a completed Conditions of Enrollment form.

Exclusions:

The following groups are ineligible for this promotion:

Association groups
Groups with more than 30% COBRA/Cal-COBRA enrollees
Groups moving from CaiforniaChoice®, HSA California® or Kaiser Permanente Choice Solution
Carve-out groups (management/non-management, salary/non-salary)
* Proof of renewal is not applicable to qualifying PEO spin-off groups, groups moving from another carrier’s Large Group contract to an Anthem Blue Cross Small Group contract or qualifying groups with no prior medical coverage. Please note that we no longer require that the effective date of the renewal information be within 90 days of the requested effective date..
** Groups of two to four enrollees can receive no lower than a 1.0 RAF; groups of five enrollees can get no lower than a .95 RAF.
 

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