Large Group Medical Insurance New Business Submission Guide

Groups 51 – 99 – Provide the following:

Check with the State Insurance Dept. for group size requirement – i.e., NY rates 100 or more for large groups.

  • Detailed benefit summaries from current carrier for the last 24 months.
  • Current bill, including rate information.
  • Renewal information including renewal letter with renewal rates.
  • Employer contributions across all tiers and plan designs.
  • History of carriers for previous five years, including name, dates, and type of plans.
  • Claim history, if available.
  • Census in spreadsheet format such as Excel:
    1. All eligible employees.
    2. Dates of birth, gender, zip codes and dependent status.
    3. Identify waivers, Medicare, Medicaid, VA, and COBRA contracts.
    4. Include spousal waivers or those covered by parents–age 26
  • Identify employee classifications and contribution amounts including any excluded classes.
  • Claims/Enrollment Activity and Claims Utilization Reports

Groups 100+

All of the above plus the information below:

  • Stop Loss Carrier Information and Terms
  • Claims activity for the past 24 months including the most recent period.
  • Information no more than six months older than the effective date.
  • Large claims activity corresponding to the claims period(s) provided.
    1. Total dollars paid for each claimant that goes over the pooling level.
    2. Status of claimant(s) — active/inactive.
    3. Prognosis.
  • Monthly contract counts, broken down by tier, corresponding to the claims period(s) provided