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Small Group Underwriting Guideline Update

The revised Small Group Underwriting Guidelines are based on the October 2021 updates and have been approved through New York State Department of Financial Services. The changes are effective immediately to ensure we are meeting all regulatory requirements for group eligibility.

The following changes are both in the group eligibility section:

  • A bullet has been added in the first section that states, “…a group is eligible if it has employees that live, work or reside in the health plan’s service area.”
    • This means a group physically located outside of our service area can cover employees that live, work, or reside inside of our service area. Only employees that live, work, or reside inside of our service area would be eligible in this situation.
  • The guideline requiring at least 25% of a group’s subscribers be in the health plan’s service area has been removed.
    • This means there is no longer a limitation on out of area enrollment when a group has a HQ in the health plan’s service area.

We hope these updates will provide additional flexibility in the small group market.

As always, if you have any questions, please don’t hesitate to contact underwriting or your account representative.

Revised Small Group Underwriting Guidelines (PDF)


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