Commercial updates
Individual AOR helpful hints. Please be aware that not every situation requires a signed Agent of Record (AOR) form. If you are transferring clients or purchasing business from another agent, simply send an email to kenzie.gray@selecthealth.org and include all agents involved. We will process those transfers effective the following month.
Small Employer ACA
To help protect the Small Employer ACA block of business, Select Health will begin monitoring group participation more closely. This may include waiving an employee’s other coverage and determining whether it is valid or not, asking questions about other plans that the employer may be offering, or requiring participation review of a group when they request to change their renewal date.
When writing groups for January 1 effective dates, remember that they still must meet the insurance definition of a group even though they aren’t required to meet the typical participation and contribution requirements (if submitted to Select Health by December 15).
- This means they must always have at least two full-time employees.
- They cannot offer any other type of health insurance plan. This provision cannot be used to “slice” and offer more than one carrier option to their employees, including health share plans.
- This provision only affects groups new to Select Health and does not apply to groups requesting a renewal change date to January 1. Any group wanting to move to a January 1 renewal needs to meet the required participation and contribution requirements.
Small Employer out-of-area allowance
Effective with October 1, 2023 new groups, Small Employer will be changing our out-of-area employee allowance to 50% in UT, ID, and/or NV, and 50% outside of these states. We’re making this change to better serve members in our core service area, align our Large and Small Employer policies, and for compliance considerations.
Consolidated Appropriations Act’s gag clause prohibition
A recent law, the Consolidated Appropriations Act (CAA), prohibits health insurance issuers and group health plan sponsors from including “gag clauses” in provider agreements. The CAA defines a gag clause as any agreement that prevents disclosing cost or quality of care information. In addition to this prohibition on gag clauses, the CAA requires group health plans and health insurance issuers to submit a Gag Clause Prohibition Compliance Attestation (GCPCA) form to HHS.
Select Health will complete the attestation on behalf of our contracted fully insured groups. However, self-funded (including level funded) groups will be responsible for completing the attestation on their own behalf.
Visit these resources for more information on the CAA’s new Gag Clause prohibition: