Small Employer Group Underwriting Guidelines

We’ve received feedback that some consultants are encouraging Small Employer groups to work outside of Select Health’s underwriting requirements. We want to remind our agents and small employers of the requirements for a group to become and remain insured under a Select Health Small Employer plan.

• Select Health does not allow another health plan to be offered in addition to a Small Employer plan. If a group is insured under the Small Employer line of business with Select Health, they are only allowed to offer our insurance and no other carrier. This includes participating in Healthcare Sharing Ministries (HCSM), a self - or level - funded plan, etc. Select Health does not allow this regardless of what another carrier may be offering.
• Select Health has the following participation requirements:
  • Employers with up to four eligible employees after valid waivers - 100 percent must participate.
  • Employers with five or more eligible employees after valid waivers - 75 percent must participate.
  • Valid waivers are those employees covered on another health plan not offered by their employer that complies with ACA - minimum essential coverage which does not include short-term plans, HCSMs, accident - only plans, etc.
• An employer could create additional risk by directing employees to an HCSM, as HCSMs are not insurance and there is no guarantee of payment. Many states have taken action against HCSMs for fraud. Also, loss of HCSM participation, regardless of the reason, does not constitute an SEP for an employee to move to a group or Individual health plan.
• An employer that encourages certain employees to select alternative plan options based on their health or similar factors could also be at risk.

Due to the above trends, Select Health will begin auditing groups if we become aware that they are offering alternative plan options in addition to a Select Health Small Employer plan.

Questions? Contact your account manager or the Small Employer Sales team at 800-442-5306, option 2.