In California, a small employer group has more than 51 employees. Outlined below are the general guidelines for large employer health plans.
The information herein includes the definition, the issuance of coverage guidelines, and the creditable coverage requirements.
Definition
51 or more employees.
Issuance of Coverage
Large group health insurance contracts, unlike small group health insurance contracts, do not have to be offered on a guarantee-issue basis. Large group health insurance is medically underwritten at the time of purchase, with rates based on employee participation and prior claims experience. However, as per the federal Health Insurance Portability and Accountability Act of 1996, all group insurance contracts, including large group contracts, must be guarantee-renewable, unless there is non-payment of premium, the employer has committed fraud or intentional misrepresentation or the employer has not complied with the terms of the health insurance contract.
Pre-existing Condition Requirements
In California, all group health insurance carriers can impose a 6-month look-back/6-month exclusionary period for preexisting conditions on enrollees that do not have prior creditable coverage.
Underwriting Requirements
In the small group market in California, private health insurance carriers can medically underwrite rates. Rates may vary by plus or minus 10 percent of the indexed rate based on the health status of the group.
Creditable Coverage Requirements
As per the Federal Health Insurance Portability and Accountability Act of 1996, credit for prior coverage is required as long as there is no more than a 63-day break in coverage.
