CA Insurance in Small Group Markets

As an employer, you have a responsibility to be aware and supportive of the issues which impact your employees and their families. Providing group health insurance can help protect your employees from enormous health care expenses that can pile up during serious or lasting illnesses, as well as protect your business from lost work hours.

Group insurance policies have some advantages over the individual policies.  A small group must consist of only 2-50 employees.  If there are just 2, it has to be someone other than husband and wife to qualify.  The waiting period for preexisting conditions is six months, as compared to one year with individual policies.  However, if you do have previous coverage it must be applied to decrease or eliminate the waiting period.

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What are statewide rules and protections for small group insurance?

CA Group Health Insurance - Guaranteed Issue:

• All products have guaranteed issue despite any preexisting condition.
• If you are self-employed, or a group of 1 person, there is no guaranteed issue.
• There are no special rules for a group of 1 person.

CA Group Health Insurance - Rate Restrictions:

• The rating restrictions are regulated by: Rate Bands.
• There are limits on rating.

CA Group Health Insurance -Pre-Existing Condition Exclusion Rules:

• The maximum look-back period is 6 months.
• The maximum exclusion period is 6 months.
• Credit is required if you have had previous coverage. 
• Continuous coverage is a special rule, and credit shall be given if a person becomes eligible for new employer-based coverage within 180 days. Qualifying factors are:
  • Persons with coverage loss because of losing employment.
  • If the employer no longer sponsors or contributes to a plan
  • The maximum lapse period allowed is 62 on most, 180 on some.

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