U N D E R W R I T I N G Q U I C K
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S M A L L B U S I N E S S G R O U P What works for you?
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UnitedHealthcare
We are proud of our commitment to agents throughout
Illinois. We recognize the value you bring to small business,
and your critical role in the partnership between small
employers and UnitedHealthcare. Our staff is dedicated to
servicing your needs and those of the employer.
The information in this guide is intended as a tool designed
to help you better understand:
• medical underwriting requirements
• life and dental product guidelines
• post-sale administrative options and eligibility provisions
Also, included in the back of this guide are a few sample
administrative forms for your reference.
Category Explanation/Requirements
MEDICAL HISTORY REQUIREMENT Medical history requirements are based on the number of eligible employees. Employees at groups with 2 to 25 eligible employees will be required to complete long-form medical histories. Employees at groups with 26 to 50 eligible employees will be required to complete short-form medical histories.
RATING STRUCTURE Rating structure is based on the number of eligible employees. Groups with 2 to 25 eligible employees will be age/sex or table rated. Groups with 26 to 50 eligible employees will be class or factor rated [employee only; employee + spouse; employee + child(ren); employee + spouse + child(ren)].
DUAL OPTION (OFFERING OPEN ACCESS) Available for groups with 10 or more eligible employees.
• All groups with 10 to 50 employees receive a 4% rate load
EXCLUDING CLASSES Not permitted for groups with 10 or less eligible employees. On groups with 11 to 50 eligible employees, up to two classes will be permitted. Examples of acceptable classes include: hourly and salaried; union and non-union; management and non- management.
REQUIREMENTS FOR NEW CASE SUBMISSION • Binder check for one month’s premium payable to UnitedHealthcare of Illinois, Inc.
• Completed Small Group Application
• Copy of the group’s most recent billing statement from the current carrier
• Copy of the most recent quarterly wage & tax statement (employee roster portion).
• Completed and signed enrollment forms/waivers for all eligible employees
• Different company names listed on past bill, wage & tax, group application, etc. will need an explanation and possible proof
Medical Underwriting Requirements /pre-sale
Medical Underwriting requirements may change and Medical
Underwriting reserves the right to request additional information as
they deem necessary. In addition, if there are discrepancies between
this document and any employer contract or certificate of coverage,
the contract or certificate of coverage will prevail.
WAGE & TAX ALTERNATIVES Type of Business Required Documentation
“C” Corporation Articles of Incorporation, Form 1120, current wage and tax or current payroll records
“S” Corporation Articles of Incorporation, Form 1120S, K-1s on
owners/partners, current wage and tax or current payroll records. (Only the shareholders of an S Corporation may collect dividends as all or a part of their wages.)
Common Ownership Have group’s attorney, accountant, or officer complete UnitedHealthcare’s standard form regarding Common Ownership.
See required sample letter attached
Partnership Partnership agreement, Form 1065 and K-1s on the part- ners of the partnership, current wage and tax or current payroll records (if employees are not partners). Only the partners of a partnership can take a draw from the company and still be considered an eligible employee. Sole Proprietorship Business license (if in business less than one year and a
Schedule C has not been filed yet) or Schedule C, and current payroll records for employees other than the owner. Only the owner of a sole proprietorship can take a draw from the company and still be considered an eligible employee.
Limited Liability LLC agreement; Either C Corporation or Company (LLC) Partnership documentation (see above). Church Form 941 and current payroll records Farm Schedule F; current payroll records
WAGE & TAX/PAYROLL REQUIREMENTS • Most recent statement
• All pages submitted
• Marked to indicate all part-time, full-time, terminated, ineligible, etc. employees
• Wage & Tax for out-of-area employee(s) needed if person(s) not listed on Wage & Tax submitted
PAYROLL RECORD REQUIREMENTS • Dated payroll and/or date of pay period
• Name of company
• Total number of hours worked by each employee
• Total number of employees
• Total taxes withheld, itemized
BILLING STATEMENT REQUIREMENTS • Most recent statement
• All terminated employees clearly marked, including termination date(s)
• Cobra/Continuation applications or waivers included if
terminated within 60-90 days and still listed on billing statement
ENROLLMENT FORM REQUIREMENTS • All medical history questions answered and explained
• Enrollment forms submitted for those in waiting period
• Signed and dated within 90 days of requested effective date
WAIVER REQUIREMENTS • Waiver section of enrollment form completed
• Reason for waiving clearly indicated
• Waivers submitted for those in waiting period
• Waiver section signed and dated within 90 days of requested effective date
EMPLOYER CONTRIBUTION REQUIREMENTS • Minimum of 50% of the single rate
PARTICIPATION REQUIREMENTS • Minimum of 50% of the eligible employees must apply
• Excluding eligible waivers, 75% of the eligible employees must apply
EMPLOYEES IN WAITING PERIOD Enrollment forms are required if a new employee is within 90 days of being eligible for coverage. If new employees in the waiting period appear on the Wage & Tax, include hire dates and either application for coverage or waiver.
COBRA WAIVERS Former employees waiving because they are covered by Cobra must complete the Medical History and waiver section of the enrollment form.
EFFECTIVE DATES/BACKDATING 1st of the month effective date:
• A group must be approved no later than the 10th of the month in order to back- date coverage to the 1st of the month.
• A new group submission should be submitted complete to Medical Underwriting no later than the 5thof the month in order to backdate the coverage to the 1stof the month.
15th of the month effective date (11-1/2 month contract):
• A group must be approved no later than the 25thof the month in order to back- date coverage to the 15thof the month.
• A new group submission should be submitted complete to Medical Underwriting no later than the 10thof the month in order to backdate the coverage to the 1stof the month.
INDEPENDENT CONTRACTOR (1099) GUIDELINES A person paid as a 1099 employee can be considered an eligible employee if:
• 1099 employee must work full-time, year-round for the employer applying for See required sample letter attached • coverage
• Employer must agree to contribute the same amount toward the 1099 employee’s premium as the taxed employees
• Employer must agree to require the same waiting period for 1099 employees as taxed employees
• Employer must agree to offer coverage to all 1099 employees in the same employment situation, including future 1099 employees
• Employer group must have a minimum of two taxed employees, and both must apply
A letter on company letterhead listing all 1099 employees and stating that the employer agrees to comply with the aforementioned conditions is required. Any 1099 employees who do not fit into the new definition of eligible should be listed with an explanation of their ineligibility.
RETIREE COVERAGE GUIDELINES • Employer must agree to contribute a minimum of 50% of the cost of the retiree’s premium
See required sample letter attached • Employer must provide documentation that current health insurance carrier is providing retiree coverage
• All eligible retirees must complete and submit the same enrollment form (includ- ing medical history section) as active employees
• Employer must agree to offer coverage to all retirees who meet these qualifica- tions, including those who retire in the future
A letter on company letterhead listing all retirees and stating that the employer agrees to comply with the aforementioned conditions is required. (A form letter is available.)
Please note: Retiree coverage is not available to groups purchasing the following products: Options PPO, Select Premier HMO, Managed Indemnity, and Select POS.
24-HOUR COVERAGE (AO COVERAGE) 24-hour medical coverage is available to owners, officers and partners of a company who are not covered under workers’ compensation. This option provides medical coverage for injuries and illnesses stemming from occupational exposures. A premium load may be assessed to the entire group, determined by the percent of employees being covered.
SEASONAL EMPLOYEES Employees working a minimum of 30 hours per week less than 9 months per year are considered seasonal and are not eligible for coverage.
PEO (“PROFESSIONAL EMPLOYEE Coverage to PEOs and their employees is not offered
ORGANIZATION”) GROUPS
EMPLOYERS UTILIZING LEASED EMPLOYEES • All leased employees must be eligible for coverage on the same basis as other employees
See required sample letter attached • The employer must complete and sign the application for coverage
• UnitedHealthcare must be the sole provider of health insurance for all eligible employees
• UnitedHealthcare will bill the employer for coverage, not the PEO
• The required eligibility information will include the standard documents for any small employer group.
CONTRIBUTION 25% or more of the employee rate
PARTICIPATION • 75% with 25% to 99% contribution
• 100% with 100% contribution
GUARANTEE ISSUE/MAXIMUM AMOUNTS • Groups with 2 to 5 eligible employees — No guarantee issue; maximum of
$50,000
• Groups with 6 to 19 eligible employees — $50,000 guarantee issue; maximum of $175,000
• Groups with 20 to 50 eligible employees — $100,000 guarantee issue; maxi- mum of $250,000
ADDING LIFE OFF RENEWAL Coverage exceeding guarantee issue amount can only be done at renewal. Coverage for guarantee issue amount can be added at any time.
SALARY-BASED LIFE Amounts may be offered for 1, 2, 3, 4, or 5 times salary (see Guarantee Issue/Maximum Amounts guidelines above)
LIFE CLASSES Differences in class amounts may not exceed 2-1/2 times
DEPENDENT LIFE The following three options are available: 1. $2,000/$1,000 (spouse/dependent) 2. $4,000/$2,000 (spouse/dependent) 3. $7,500/$3,750 (spouse/dependent)
RETIREE COVERAGE Not available
SHORT-TERM DISABILITY Not available
Life, AD&D, Dependent Life Guidelines
CONTRIBUTION 50% or more of the employee rate
PARTICIPATION • 75% of eligible employees, net of waivers
• Minimum of 50%, including waivers
Note: It is not required that the same employees that choose medical coverage also choose dental coverage.
PLAN DESIGNS Various PPO plan designs are available for groups of 2 to 50 eligible employees. Please review our Benefit Options Checklist or Dental brochures for more information.
Dental Guidelines
Category Open Access or Select HMO Options PPO, Select Premier HMO, Managed Indemnity, or Select Plus POS
INVOICE FREQUENCY Monthly
GRACE PERIOD 31 days (This is the number of days during which UnitedHealthcare will wait for payment without terminating the group. This is not necessarily an interest-free period.)
Payment is due the 1st of each month. If no payment is received within 10 days after the due date the collection process will start. A reinstatement charge will be assessed to any reinstated group. Only one reinstatement is allowed during a contract year and is not guaranteed.
DELINQUENT POLICY A policy that is not paid by the due date is considered delinquent and late charges may be assessed against any delinquent policy.
MANDATORY ENROLLMENT INTO PRODUCTS If the employer contributes 100% toward any ancillary (life and AD&D, dependent life, or dental) premium, then the employees must elect that product’s coverage. It is mandatory.
RETROACTIVE ADDITIONS 60 days from the effective date 30 days from the effective date
RETROACTIVE TERMINATIONS 60 days from the effective date
BILLING CUTOFF DATE FOR EMPLOYEES 15thDay Rule If Date of Event administration is
• Effective on or before the 15thof the chosen, monthly fee is prorated. month — bill full month
• Effective on or after the 16thof the month — will not be billed until the 1st of the following month
• Termination on or before the 15thof the month — full month credit.
• Termination effective on or after the 16thof the month — full month premium charged.
Please note: Proration is only done on a new group if the effective date is other than the 1stof the month (i.e., the 15th).
DATE OF BIRTH CALCULATION At group’s renewal date 1stof the insurance month following date of birth
MAXIMUM NUMBER OF CHILDREN BILLED 3 3
(AGE/SEX-RATED GROUPS)
OPEN ENROLLMENT PERIOD Month prior to renewal
Standard Administrative Options /(post-sale)
DEPENDENT/STUDENT MAXIMUM AGE Unmarried child up to 19 years/Unmarried child up to 25 years
EFFECTIVE DATE FOR NEW HIRES • 1stof the month following waiting • Date-of-event administration — 1st period (up to six months); or • of the month following waiting
• Date of hire; or • period (up to six months); or
• 1stday following waiting period (up to • Non-date-of-event administration
six months) • — date of hire
MINIMUM HOURS WORKED PER 30 to 40 hours (determined by employer group)
WEEK TO BE ELIGIBLE
EFFECTIVE DATE OF TERMINATION Date of term (see 15thDay Rule under • Date-of-event administration — Billing Cutoff Date above) • last day of the month in which the
• term occurs
• Non-date-of-event administration
— date of term
EFFECTIVE DATE FOR RETURN TO Date of return • Date-of-event administration —
EMPLOYMENT (LEAVE, STRIKE, LAYOFF) • date of return
• Non-date-of-event administration
— 1stof the month following date of return
DATE FOR STATUS CHANGE Date of change (see 15th Day Rule under • Date-of-event administration — Billing Cutoff Date above) • date of change
• Non-date-of-event administration
— 1stof the month following change
EVENTS Newborn; marriage; divorce; adoption; hardship; death; loss of other coverage
DUAL COVERAGE (EMPLOYEE WORKS FOR Not allowed
2 EMPLOYERS AND IS COVERED UNDER BOTH POLICIES)
DOUBLE COVERAGE (HUSBAND/WIFE WORK Not allowed
FOR SAME EMPLOYER AND COVER EACH OTHER)
HANDICAPPED COVERAGE Yes, covers above and beyond maximum dependent age. Requires documentation from physician.
EMPLOYER PLAN TERMINATION UnitedHealthcare may terminate group coverage for:
• Nonpayment of premiums (The group is liable for payment of premiums for the entire term the policy is in force, including the grace period.)
• Not meeting contribution requirements (31 days’ advance notice)
• Not meeting participation requirements (31 days’ advance notice)
VOLUNTARY TERMINATION Coverage may be terminated on the date specified by the policyholder, after at least 31 days’ prior written notice to UnitedHealthcare. The written notice must be signed by an officer of the group/policyholder.
Exclusions and coverage limitations are detailed in the certificate of coverage. If this document conflicts in any way with the certificate of coverage, the certificate’s provisions prevail.
Standard Eligibility Provisions /(post-sale)
Common Ownership
Please have this form completed and signed by the enrolling group’s
Accountant, Attorney or Officer of the Company
The Health Insurance Portability and Accountability Act of 1996 states that all persons
treated as a single employer under subsection (b), (c), (m), or (o) of section 414 of the
Internal Revenue Code of 1986 shall be treated as one employer.
Please list all companies that would qualify as one employer under the above referenced
sections of the Internal Revenue Code.
Name of Group on Employer Application
BUSINESS NAME EMPLOYER IDENTIFICATION NUMBER
I certify that the applicant is a single employer under section 414 of Internal Revenue Code
of 1986 [26 U.S.C. § 414 (b), (c), (m), or (o)], and under any applicable state law.
Signature: Date:
Relationship to Company (e.g. Attorney, Accountant or Officer):
Independent Contractors Paid by 1099 Form
It is possible for an Independent Contractor paid by 1099 Form to be considered
eligible for your UnitedHealthcare group health plan. It is your choice as the
employer to consider these individuals to be eligible for coverage. Should you
choose to include these individuals in your group health plan, UnitedHealthcare
requires you and the Independent Contractor to meet the following guidelines:
1) The Independent Contractor paid by 1099 must work for your company on a full-time,
year-around basis.
2) You, the employer, agree to contribute the same amount of money toward the premium
as you would for your regular, taxed employees.
3) You, the employer, agree to require the same waiting period for Independent
Contractors as for your regular, taxed employees.
4) You, the employer, agree to extend the coverage offering to all Independent Contractors
who meet these qualifications, including those you may hire in the future.
5) Your business has a minimum of two regular, taxed employees who are applying (possibly
including yourself).
If you agree to meet all of the above requirements, you may consider your Independent
Contractors eligible for your group health plan. Please list below all individuals who meet these
qualifications.
Name Social Security Number Date of Hire
I agree to the above qualifying conditions to consider Independent Contractors eligible for the
group health plan sponsored by my company, and attest to the accuracy and completeness of the
information given here.
Retirees Eligible for Coverage Under the
Group Health Plan
It is possible for a retired former employee to be considered eligible for your
UnitedHealthcare group health plan. It is your choice as the employer to consider
these individuals to be eligible for coverage. Should you choose to include these
individuals in your group health plan, UnitedHealthcare requires you and the
Retiree to meet the following guidelines:
1) You, the employer, must agree to contribute a minimum of 50% of the cost of the retiree’s
health coverage.
2) You, the employer, must provide documentation that your current health carrier is offer-
ing retiree coverage.
3) All eligible retirees must complete and submit the same health application as the active
employees.
4) You, the employer, must agree to extend the coverage offering to all retirees who meet
these qualifications, including those who may retire in the future.
If you agree to meet all of the above requirements, you may consider your retirees eligible for
your group health plan. Please list below all individuals who meet these qualifications.
Social Date of Start Date of
Date of Security Qualifying Current Group
Name Birth Number Employment Coverage
I agree to the above qualifying conditions to consider retirees eligible for the group health
plan sponsored by my company, and attest to the accuracy and completeness of the information
given here.
PEO/Leased Employee Verification Form
Small employers who want to include their leased employees in their group health
plan must meet the following criteria:
1) As the employer, I have the sole authority to hire and fire the leased employees.
2) All leased employees must be considered eligible for coverage on the same basis as
non-leased employees.
3) The total number of eligible employees (leased and non-leased) will be used to
determine if the group qualifies as a small employer under federal and state law.
4) UnitedHealthcare must be the sole provider of health insurance for all eligible
employees (leased and non-leased).
5) An officer of the small employer (not the PEO or Leasing Company) must complete
and sign the application for coverage.
As a small employer with leased employees, I agree to the above conditions and documentation
requirements enabling me to consider my leased employees eligible for, and included in, the
health insurance benefits offered by my company.
Name of Business
Business Owner’s Signature Date
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