Under ACA beginning with all new groups and for groups renewing in the 2014 calendar year the following criteria will be used to underwrite group. (In Florida, group size is determined by ATNE, Average Total Number of Employees. ATNE is calculated by averaging the total number all employees, full & part time, seasonal, temporary, etc… for each month.
Group Size below 50 lives – Small Group Underwriting
Small group health insurance carriers will only be allowed to price small groups based on the following criteria:
1. Smoking status (tobacco status can be rated as a 1.5-1.0 limit)
2. Regional rating
3. Limit of a 3-1 ratio in premium charges (mature vs. younger)
4. Family size
5. Participation in a health promotion (wellness) program
Pre-existing condition limitations are removed.
Group Size 51-99 lives – Small or Large Group Underwriting as determined by state
Composite rates based on DOB, gender, home zip code, enrollment status, prior carrier history, renewal rates and group medical questionnaire.
Group Size of more than 100 lives – Large Group Underwriting
Underwriting allows for, in addition to the above, review of each individuals (employee and dependents) medical conditions.
Self-Funded Underwriting, any size group, allows for individual (employee and dependents) medical condition.
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