Underwriting Guidelines for Large Groups

  • Employer Groups (51 - 100 employees)

    Group Eligibility

    Group is required to be based or have a clearly defined division in Washington.

    Minimum Size

    Ten employees must be enrolled at all times with Premera Blue Cross.

    Employee and Dependent Definitions

    An eligible employee meets the following requirements:

    • Regularly works at least 20 hours per week
    • Is listed on the employer's regular payroll
    • Is actively at work at the employer's regular place of business or other location to which employee is required to travel to perform the regular duties of employment
    • Has met employer's applicable probationary period
    • Resides or works in a Premera-approved service area
    • Is not covered by a collective bargaining agreement
    • Is covered by Workers' Compensation subject to verification, as required by law

    An eligible dependent meets the following requirements:

    • An employee's lawful spouse, unless legally separated who is not an eligible employee, not on active duty in the armed forces and resides in an approved service area
    • An employee's child or the child of the employee's lawful spouse, including a legally adopted child or stepchild who is not an eligible employee, who resides in an approved service area and is under age 26

    Contribution and Participation

    • Employer must contribute a minimum of 75 percent toward employee monthly health plan bill rate or a minimum of 50 percent toward the total cost of the program
    • A minimum of 75 percent of eligible employees must enroll. When the employer contributes 100 percent toward the employee cost, all eligible employees must participate
    • When dependent coverage is elected, the employer is not required to contribute to the dependent cost
    • Dependent coverage minimum participation varies

    Eligible Participation Exclusions

    Employees and dependents with other verifiable medical coverage are considered eligible participant exclusions and do not count against a group's employee or dependent participation requirement.

    Multiple Product Offerings

    • Eligible for multiple product offerings
    • One preferred, one traditional and/or one HMO product
    • All benefits must be offered to all employees, unless differentiated by distinct employee classification
    • High deductible plan may not be offered with a low deductible or copay plan

    Employer Groups (100+ employees)

    For large group underwriting guidelines, please contact your sales representative.