• Underwriting Guidelines

    Small Groups (1 - 50 employees)

    Group Eligibility

    A group is required to be based in, or have a clearly defined division in Washington

    Minimum Size

    The group must have at least one, but no more than 50 employees, working 20 or more hours per week

    Employee and Dependent Definitions

    An eligible employee must meet 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 Worker’s Compensation subject to verification, as required by law

    An eligible dependent must meet the following requirements:

    • An employee’s lawful spouse (or qualified domestic partner), unless legally separated who is not an eligible employee, and resides in an approved service area;
    • An employee’s child or the child of the employee’s lawful spouse (or qualified domestic partner), including a legally adopted child or stepchild who is not an eligible employee, resides in an approved service and is under age 26

    Group Verification

    All groups with four or fewer employees enrolled are required to provide copies of their Washington State Employment Security Quarterly Wage Detail Report (form #EMS 5208 B), or most recently filed IRS forms. Sole proprietors may submit IRS form 1040, along with a Schedule C, Schedule C-EZ or Schedule F, and any associated W-2’s if married filed jointly. Partnerships may submit IRS form 1065. Corporations may submit Form 1120/1120A.

    Contribution

    Groups of 1 to 3 Employees

    • Employers are required to contribute 100 percent of the employee cost
    • When dependent coverage is elected, employers are required to contribute a minimum of 50 percent of dependent cost

    Groups of 4 to 50 Employees

    • Employers are required to contribute a minimum of 75 percent of the employee cost, or 50 percent of the total cost for all rate tiers
    • When dependent coverage is elected, employers are not required to contribute to the dependent cost

    Participation

    Groups of 1 to 3 Employees 

    • A minimum of 100 percent of eligible employees is required to enroll
    • When dependent coverage is elected, a minimum of 75 percent of the eligible dependents are required to enroll

    Groups of 4 to 50 Employees 

    • A minimum of 75 percent of the eligible employees are required to enroll
    • Minimum of 25 percent of eligible dependents are required to enroll

    Eligible Participation Exclusions

    In all group sizes, employees with other verifiable group medical coverage are considered eligible participation exclusions, and do not count against the employee participation requirement. Employees with Individual medical coverage are not considered eligible participation exclusions and will count against a Group’s employee participation requirement.

    Multiple Product Offerings

    Groups of 1 to 50 enrolled employees are not eligible for multiple product offerings