Writing with Anthem Just Got Easier – Find Out How!

Relaxed Participation? No DE9C Required? Writing with Anthem Just Got Easier! 

Anthem wants to make it easier for you to write business now through 6/15 effective dates. The new Q2 updates include: 

  • Relaxed participation! Only 25% participation for groups of 5 or more enrolled subscribers required, and 65% participation for 4 or less subscribers enrolled.
  • Individual coverage for on- and off-exchange will be accepted as a valid waiver (in addition to employees waiving due to Medicare, Medi-Cal or military – as well as those covered as a dependent on a spouse’s or parent’s employer sponsored group plan).
  • DE9C not required with 6 or more subscribers enrolling. Groups with prior coverage must submit prior carrier bill and excludes virgin groups.
  • Dual HMO Networks! (Dual network no longer offered for PPO). Groups can select both HMO networks to be offered alongside each other!

Anthem’s CA Small Group Q2 2019 Rate Action:
Quarterly Rate Change Average:
PPO: 4.5%
HMO: 4.8%
Combined: 4.5%
Annual/RenewalRate Change Average:
PPO: 5.7%
HMO: 0.8%
Combined: 5.1%

Kaiser Announces Reduced Participation Rate for Small Group Eligibility!

Kaiser is now offering reduced participation for small groups with effective dates from September 1, 2018, to April 1, 2019. Groups will only need 50% participation rate instead of 70%.* Only 50% of a group’s eligible employees will need group health coverage to offer Kaiser Permanente. For more information on this promotion, please click here 

Kaiser Permanente will apply a lower 50% minimum participation requirement automatically for groups being re-certified for renewal dates between September 1, 2018 and April 1, 2019, although their contract currently reflects a 70% participation requirement. The group will not be terminated at renewal provided they meet all underwriting criteria and the lower minimum of 50% participation in a group health plan.

As a reminder, Kaiser has announced that it has extended its NO DE 9C with Six or More Enrolling* promo and four weeks of payroll through March 2019 effective dates. The original promo was announced in September 2017 for new small groups with effective dates through January 2018. Kaiser recognizes that many start-up businesses do not have six weeks of payroll for their employees. This relaxed criterion affords earlier enrollment for groups that may not have otherwise qualified and supports their ongoing campaign of being “easier to do business with.”   For more information, please contact your Dickerson Account Executive. 


ACA Reporting Update – Extended Deadline Announced

Despite a court ruling by a federal judge in Texas that the Affordable Care Act (“ACA”) is unconstitutional, all ACA coverage and reporting obligations for employers remain in place.

The IRS has published final forms and instructions to help employers prepare for the upcoming ACA reporting deadlines.   

The IRS has extended the due dates for 1095 forms C or B that go out to employees due March 4, 2019, instead of January 31, 2019.  This does not change the due date for form 1094 that’s due to the IRS with copies of forms 1095 by February 28th (Paper Filing) or April 1st (Electronic filing with the IRS).

The IRS also extends “good faith compliance efforts” relief for 2018 in certain circumstance where incorrect or incomplete information was reported in good faith on a statement or return. The relief does not apply to a failure to timely furnish a statement or file a return. For additional information, see IRS Notice 2018-94

Applicable Large Employers who had 50 or more full-time or full-time equivalent employees during 2017 are required to complete the reporting forms 1095-C and 1094-C.  Self-funded plans with less than 50 employees are to complete forms 1095-B and 1094-B.

Below are links to the final forms and instructions on the IRS website:

Compliance Corner 

JANUARY 31, 2019: Forms W-2 and 1099 (when applicable) due

Employers must provide all employees copies of Form W-2 reporting earnings and taxes for 2018 by January 31, 2019. When applicable, employers must provide Forms 1099 to contractors who earned more than $600 in business-related payments in 2018.