Eligible Employees

Full-Time

Employees must be employed on a permanent, full-time basis and have a normal work schedule of at least 30 hours per week. In addition, they must be compensated for that work by the employer (subject to withholding appearing on a W-2 form).

Part-Time

Employees must be employed on a permanent, part-time basis and have a normal work schedule of at least 20, but no more than 29 hours per week. In addition, they must be compensated for that work by the employer (subject to withholding appearing on a W-2 form). NOTE: It is the employer’s option to offer health coverage to part-time employees. If that option is exercised, all similarly situated individuals must be offered coverage under the employer’s benefit plan.

Sole Proprietors/Partners/Corporate Officers

Sole proprietors, partners, and corporate officers must work at least 20 hours per week.

Ineligible Employees Temporary, seasonal or substitute workers and persons compensated on a 1099 basis are not eligible to enroll in a Anthem blue cross Small Group plan.

Cal-COBRA, COBRA-, FMLA-Eligible Groups

Employers who are qualified for coverage under Cal-COBRA (California law SB719), COBRA (Federal Omnibus Budget Reconciliation Act) or FMLA (Family and Medical Leave Act) must complete a questionnaire, indicating the qualifying event and the date continuation coverage began.

Eligible Dependents

An eligible dependent has one of the following relationships with an eligible employee:

Effective Date

The date coverage takes effect for a group must be the first or fifteenth of a month.

Employer Waiting Periods

After employees are hired, there may be a specific period they must be employed, known as an employer waiting period, before they and their dependents become eligible for group coverage. The employee’s eligibility date is the first of the month after the waiting period ends. Employers may choose a waiting period of the first of the month following an employee’s date of hire, or one, two, three, four, five or six months of employment before eligible for benefits.

Spouses

A husband and wife employed at the same company may both be covered as employees. Children may be considered the dependents of either one or both of the employees.

Adding Employees and Dependents

New employees and dependents must submit completed applications to Anthem blue cross within 30 days of becoming eligible for coverage. Applications must be received no later than the last day of the month prior to the requested effective date.

Declining Coverage

Employees who choose not to participate in a group’s health plan must decline coverage by completing Sections 2 and 4 of the Small Group Employee Application within 30 days of becoming eligible.

Late Enrollment

Employees and dependents eligible for coverage who choose to enroll at a later date may be considered late enrollees. Late enrollees will be subject to a 12-month waiting period from the date they apply.

Waiting Period for Preexisting Conditions

A preexisting condition is an illness, disease or physical condition for which medical advice, diagnosis, care or treatment was recommended or received from a licensed health practitioner during the six months before the effective date of coverage or the first day of the waiting period, whichever is earlier. If an employee or dependent applies for coverage within 62 days of terminating membership in an individual health care plan, or within 180 days of terminating coverage in a group health care plan, or within 180 days of terminating coverage in a group health care plan, Anthem blue cross will credit the time enrolled in the previous plan toward the preexisting condition waiting period.

Term of Coverage

Coverage remains in force as long as the group pays the required premium on time and remains eligible for membership. Coverage will cease if the group becomes ineligible for reasons including, but not limited to, the following:

Employer Contributions

Employers must contribute at least 50 percent (60 percent for Employee Elect) of the employee’s medical and dental premiums and 25 percent of the employee’s life premium. The employer is not required to contribute to the cost of dependents’ coverage.

Employee Participation

If an employee contributes to the medical and dental premium, at least 75 percent of eligible employees must enroll. If an employer is paying 100 percent of employees’ medical and dental premiums, all eligible employees must enroll. An employee who declines coverage because he or she is covered by a spouse’s employer’s group medical or dental plan may be excluded in determining participation.

Out-of-State Employees

The majority of enrolling employees (51percent) must be employed within the state of California. Residents of Hawaii are not eligible.

Rate Guarantees

Medical rates may be guaranteed for six or twelve months. The rating formula for the group will not change during the guarantee period. Beyond the guarantee period, Anthem blue cross reserves the right to change rates, change coverage or amend the group’s contract with 30 days’ notice as permitted by law. A group member’s rate may be adjusted at any time because of changes in the following:

Changes in Coverage
A group may request a coverage, plan or benefit change once in a 12-month period. Requests for coverage changes must be received 30 days prior to the requested effective date, and these requests are subject to underwriting review.

Certain change requests can only become effective on the group’s anniversary date and may be subject to underwriting review, including the following:

NOTE: A benefit modification does not initiate a new rate guarantee period.

Workers’ Compensation

To obtain a Workers’ Compensation quote, submit the items listed below to Fremont Compensation Insurance Company at the following fax number: 1-805-499-7214.

To accept Fremont’s quote for Workers’ Compensation coverage, submit a company check for the required deposit premium listed on Fremont’s quote cover letter to the following address:

Fremont Compensation Insurance Company
P.O. Box 9057
Oxnard, CA 93031

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