No DE9C Promotions/Guidelines

Click here for downloadble PDF.

Carrier

Quarterly Wage Report/DE9C not required for:

Guideline:

Promotion through 3/31/2022

  • No DE9C is required for 5+ enrolling.
  • Excludes Virgin groups, Groups with 10% of EEs residing out of CA, and groups with more than 20% COBRA enrollments. 

Underwriting Highlights:

  • Pick 10: mix and match any combination of plans and networks.
  • Participation Promotion (Q3 ’21 through Q1 ’22): Small groups enrolling 5-100 need to meet 25% participation. Standard 60% participation applies to groups enrolling 4 or less subscribers.
  • QWTS Requirements: Quarterly Wage & Tax Statements not required on groups enrolling 5 or more. QWTS is required for groups with less than 5 enrolling, no current employer group coverage, more than 10% of employees located outside CA, or more than 20% are COBRA/Cal-COBRA employees.

Note: Information is subject to change and carriers can request additional documents as needed.

Guideline:

Promotion through 3/15/2022

No DE9C required for 3+ enrolled

  • Must provide a copy of the most recent prior carrier bill.
  • Payroll is required for eligible employees not listed on the bill
  • New hire letter if required for newly hired employees not yet listed on the prior carrier bill or payroll
  • Virgin groups are excluded from promotion.

Underwriting Highlights:

  • Statewide Network Flexibility Promotion: Employers can choose 2 PPO Networks with 1 HMO or 2 HMO Networks with 1 PPO.
  • Relaxed Participation: Enrolling 5+ need to meet 25% participation. Standard 65% participation applies for 4 or less subscribers.
  • Valid Waivers: Individual coverage both on and off the exchange will be accepted as a valid waiver (in addition to waivers due to Medicare, Medi-Cal or military, or covered as a dependent on a spouse or parent’s group plan).

Note: Information is subject to change and carriers can request additional documents as needed.

Guideline:

  • 3 to 95 enrolling
  • Blue Shield reserves the right to require the following documentation for groups of  3 to 95 enrolling:
    • The group’s most recent DE9C Quarterly State Tax Withholding Statement
    • Payroll register for employees hired after the DE9C filing or if any employees are out of state

Guideline:

No DE9C is required for 6 + enrolling

  • A copy of the most recent prior carrier bill is required
  • Must submit payroll for EE’s enrolling that are not listed on the prior carrier bill.

Guideline:

DE9C not required for Sole Proprietors.

Guideline:

Required.

Guidelines:

Promotion through 3/31/2022

  • Enhanced Choice A & B Promo: No DE9 required for 5+ enrolled: No DE9C or prior carrier bill required. Health Net can be written alongside other carriers. Now employees enrolled on another carrier through the same employer plan will not count against participation.
  • Sell HMO with 6 Package: NoDE9C required for groups of 6+ enrolled

Note: Information is subject to change and carriers can request additional documents as needed.

Promotion (no end date):

Groups of 6+ enrolling
Business Documentation required (example: business license/SOI)
Start Up groups and groups leaving a PEO do not qualify for this promotion.

Guideline:

Required.

Promotion through (No end date):

Groups with 7+ enrolling. Must provide prior carrier’s bill, and 80% of employees on prior bill must be listed in present enrollment.
Groups with more than 5 eligible employees with less than 5 enrollees due to valid waivers are still eligible for this promotion.

Guideline:

Required.

Guideline:

Required.

Guideline:

1-9 enrolling: Required
10+ enrolling: Can submit a completed and signed Participation Certification form in lieu of a DE9C. If in business less than a year, submit at least one applicable tax document.