New Groups General Guidelines

GENERAL GUIDELINES FOR ALL NEW BUSINESS

  1. The company must conduct its business year-round and not be seasonal in nature.
  2. An employer/employee relationship must exist for eligibility.
  3. Groups applying for coverage without a Federal ID number must produce evidence of legal business status.
  4. Eligible employees must be employed on a full-time basis with at least 30 hours per week.
  5. Employees must have earnings reported on a W-2.
  6. A Business Employee Eligibility Verification Statement must be completed for 2 subscriber employer groups that do not have earnings reported on a W-2.
  7. COBRA and disabled persons eligible for coverage must be included and noted in the census for rating purposes.
  8. Waiting periods cannot exceed 90 days.
  9. The employer must attest to the small group or large group status by signing the rating page.
  10. The rating page is an attachment to the group contract.

SMALL GROUP (2 to 50 full time equivalents)

In addition to the general guidelines for Small Groups the following apply:

  1. Small group new business quoting is exclusively done through the broker portal on our website. A username and password are required. Please contact your Broker/Client Relations Representative if you need access to the portal.
  2. The following information is needed:
    • Employer address and zip code
    • Effective date
    • Census to include: Employees and dependents names, Gender, DOB, Contract Type
  3. No coverage for retired or early retirees

LARGE GROUP (51 to 99 full time equivalents)

  1. The following information is needed:
    • Census to include: Relationship (E, S, D), Last Name, First Name, Gender, DOB, Zip Code, DOH, PT/FT Status, Contract Type (EE, ES, EC, Fam, Waiver, WP), Plan Election, COBRA. Electronic Excel spreadsheets preferred.
    • Current and Renewal Benefit Summaries and Rates
    • Completed Group Health Questionnaire
  2. No coverage for retired or early retirees

LARGE GROUP (100+ full time equivalents)

  1. In addition to the 51 to 99 group size required data, the following information is needed:
    • Medical and Rx monthly claims experience (24 months carriers reporting)
    • Claims information over $25,000 per member with diagnosis, prognosis and status
    • Renewal calculation exhibit with the rate adjustment

SUBMISSION

Ensure the following items are included when submitting a new sold group:

  1. Employer Group Enrollment Application
  2. Premium Rate Summary 3) Signed Group Health Care Contract
  3. Employee Enrollment Application and Change in Coverage Form
  4. Signed Group Health Care Contract
  5. If 4 or fewer employees are enrolling, a copy of Employer’s Quarterly Tax and Wage Report 9DOL-4N) is required.
  6. First month’s premium payment required with groups submission. Mail checks to: Alliant Health Plans, P.O. Box 2627, Dalton, Georgia 30722.
  7. Auto Pay Form (must be received and processed no later than the 15th of the month prior to the effective date, if elected).