REVISED PARTICIPATION SMALL GROUP GUIDELINES

Blue Cross and Blue Shield of Illinois (BCBSIL) has introduced revised participation guidelines for 2-150 segment standard product groups. Beginning with July 1, 2012, effective dates and beyond, new and renewing groups will be able to take advantage of enhanced participation rules.

Under the BCBSIL prior Employer Contribution participation rule, the required minimum employer contribution is 25%. No policy will be issued or renewed unless at least 75% of eligible employees have enrolled for coverage.  This 75% could be reduced by valid waivers, but under no circumstances be less than 50%.

New Participation Rules
To help meet the needs of your existing customers and prospective clients, BCBSIL has implemented some changes to its guidelines.

New rules: “The required minimum Employer contribution is 25%. No policy will be issued or renewed unless at least 70% of eligible employees have enrolled for coverage. This 70% number can be further reduced by valid waivers, however in no event shall the policy be issued or renewed unless at least two (2) eligible employees have enrolled for coverage.

Here’s an example for you to consider
20 full time employees in a group. 10 are waiving due to spouse’s group coverage and Medicare coverage. 3 are waiving coverage due to current individual coverage.

Participation is 7 out of 10 eligible employees. Therefore, only 6 out of 10 employees would not be eligible.  This case would be eligible for BCBSIL group coverage.

Forms and Systems Updates
The BCBSIL Small Group (Form # GA-10-9-SMGRP) benefit program application (BPA) is in the process of being revised to display the new guidelines. In the interim, the new language can now be found in the Additional Provisions sections of the BPAs posted to the BCBSIL producer and employer portals.

  (top)

Group Markets

  BCBSIL Home Run New Sales Bonus Program

Contest Rules for New Sales Bonus

Sales eligible for calculation of the New Sales Bonus include new BCBSIL Small Group-rated accounts (health plans with 2-150 enrolled employees) sold with effective dates from August 1, 2012, through October 15, 2012.

PLEASE NOTE:  There is a two-group minimum that must be sold to obtain the bonus.
------------------------------------------------------------------------------------------------------------

Humana Group Bonus 

You have four ways to generate a bonus from Humana:

• Grow your Humana medical case count up 15 or more new cases and earn a $15,000 bonus
• Add specialty benefits to a new or existing Humana medical plan
• Capture Clean Case Bonus of up to $250 plus $50 per specialty line of cover for 2–50 enrolled
• Place Humana Specialty with or without group medical to generate up to $2000 bonus per case 

Other Humana product news will bring you a medical premium discount on small groups of 2–99 eligible employees with specialty benefits and receive 0.5% premium discount for each product, up to a maximum 2%, or add a medical, vision, life, disability or dental plan for a 2% bonus per product, up to a maximum of 8%.

Premium Discount For Individual HSA Family Coverage

Write a Family Plan on the BlueEdge HSA with a $2600 deductible or higher, and that policy will receive a 20% premium discount off new business rates.

EXAMPLE:

BlueEdge $2600 deductible plan

53 y/o male = $255.98

50 y/o female = $252.56

Family coverage = $508.54 – 20% = $406.83

Medicare Supplement Billing Options

BCBSIL is now offering new billing options for Medicare Supplement policies.

You can choose either to have premiums deducted automatically from a checking or savings account or have the premium billed by mail.

There are 5 payment cycle options from which to select:  monthly, bi-monthly, quarterly, semi-annually or annually.

   (top)

Individual Market Opportunity!

A Certificate of Creditable Coverage Can Offset the Pre-Existing Waiting Period on New Under-65 Policies

Good News! The pre-existing waiting period on your client's new Blue Cross and Blue Shield of Illinois (BCBSIL) individual policy can now be offset by prior individual or group coverage with another carrier as long as:

• Application is received on or after July 1, 2012
• The prior coverage was an individual or group policy  
• There was no more than a 63-day lapse in coverage between the cancellation date of the prior carrier's individual or group policy and the signature date on the BCBSIL application for coverage
• A Certificate of Creditable Coverage is received with your client's BCBSIL application

Creditable coverage does not include:

• Accident only or disability income insurance
• Liability insurance or coverage issued as a supplement to liability insurance
• Worker's Compensation
• Credit-only insurance
• Coverage for onsite medical clinics
• Dental or vision benefits
• Long-term care, nursing home care, home health care or community based care coverage
• Coverage for a specified disease or illness
• Hospital indemnity