BCBS of NC New Simplified Underwriting 2013

10+ Simplified Underwriting 2013

for BCBSNC Sales Staff and Producers June 17, 2013


All of the paperwork, processes and rating that used to apply to groups with 16+ enrolled now

applies to 10+ enrolled. Paperwork requirements are still based on number enrolled not number
eligible. We still need a bill and census to quote. We don’t need a renewal to quote.

Virgin groups (i.e., no prior group carrier) with 10+ enrolled will be required to complete

individual applications with health questions (Enroll 1). The rule just extended to 10+ since
Simplified Underwriting dropped to 10+.

The health questions on the Employer Risk Appraisal (ERA) must be completed in their entirety for

groups of 10+ applying. Individual health applications required for groups with 1-9 applying.

Once rated, a 10+ group may submit individual applications with health questions if they would like

to pursue the opportunity for a better Risk Adjustment Factor (RAF). This process used to be in
place for 16+ and now applies to 10+.

The ability to get Simplified Underwriting will be based on the date the quote was received, not

the effective date. Simplified Underwriting is available to groups of 10+ enrolled, received on or
after June 18, 2013. Therefore, if you receive a 10+ July 1 group that was received June 19, 2013
or later, Simplified Underwriting will apply.

Simplified Underwriting will not apply to July 1 groups that were already submitted and final rated

or in process prior to June 10, 2013. Rates for those cases will stand for 90 days from the
signature date on the ERA as normal.

If the group did not enroll and resubmits after 90 days has passed, then the prospect would follow

the new Simplified Underwriting rules since the previous quote will no longer be valid.

A short enrollment form (Enroll 2) is required for enrolling a group of 10+ enrolled. Declines

continue to be required for those rejecting coverage. The Decline is now a part of the Enroll 2

Spreadsheet enrollment is now available to groups of 10+ enrolled. Decline forms are also required.

Reminder – groups with 1-9 employees applying/enrolling will continue to be required to submit

Enroll 1 forms with Health Questions for rating and will be age-band rated.

10+ Simplified Underwriting Groups will NOT be allowed to participate in the Renewal Rate Match

Program. This will continue to be available to new groups with 16+ employees applying through
December 1, 2013.

Early Renewal Program Note: These groups, as with all other new groups from July to November 2013,

will be able to use the RAF for December 1, 2013 Early Renewal Quote and Rates.

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