Significant Changes Coming To Blues’ Underwriting Policies

These changes will affect the way you do business and the information that you access.

Beginning next year, there will be some significant changes coming to the Blues’ underwriting policies that will affect your daily work. These changes are coming in response to the implementation of the Affordable Care Act and BCBSM’s transition to a nonprofit mutual. Because they will impact your daily business, it’s critical that you understand the changes. It’s important to note that the underwriting policy manuals apply to business enrolling off-SHOP only and the changes are applicable to both BCBSM and BCN unless required by law or business process.

What is changing?
There are numerous changes that you’ll see in the group underwriting policy manuals many of which have been communicated in prior Focus on Reform alerts and training sessions (See below for instruction on how to access to alerts). To give you an idea of what is coming, we’ve highlighted a few of the impacts below:

I.    Eligibility

a.    New definitions for small and large groups to align with the ACA, changes to participation and employer contribution rules, and benefit package guidelines including new small group wrapping rules.

b.    New common control guidelines to align with the ACA  

c.    Multiple location employer guidelines were updated to reflect a single geographic rating area for ACA small groups (50 or fewer FTE employees)

d.    Eliminated  the minimum of 5 enrolled active employee requirement to establish a retiree segment and only applying the 50-percent employer contribution requirement to ACA small groups (50 or fewer FTE employees)

II.    Group rating (BCBSM only)

a.    Changes in  rating methodology for small groups to comply with the ACA
b.    Large non-reform groups will be age-rated beginning with 2014 renewals

III.    Ancillary coverage, Dental and Vision

a.    Prescription drug policy changes (Single Source). See Focus on: Reform – Issue 9, May 27, 2013.
b.    Large group stand-alone vision and voluntary stand-alone vision coverage is available Jan. 1, 2014, when packaged with stand-alone dental

IV.    Membership processes

a.     All membership addition notice requirements were changed from 30 to 31 days. Deletion and cancellation notice requirements remain at 30 days. (Applies to all groups effective Jan. 1, 2014)

V.    Group processes

a.     Updates to lead time requirements, effective date, renewal date, plan year alignment and new hire waiting periods
b.    Beginning with Jan. 1, 2014, effective dates, group-wide changes are not permitted with effective dates 150 days prior to a group’s renewal period. This applies to benefit, industry class and geographic rating area changes. GWCs must be effective the first of the   month
c.    Changes to Rate Renewal Certification processes.  See Issue 9: Focus on: Reform bulletin – May 13, 2013

When will those changes take place?
The new rules in the policy manuals will be effective either on Jan. 1, 2014, or on the groups’ plan year date beginning Jan. 1, 2014. 

Where can I see the changes?
To view the new and current policy manuals:

1. Go to www.bcbsm.com 
2. Log in to the Agent Secured Services.
3. Go to the Quote & Enroll tab. Select Underwriting Policy.
4. Click on either BCBSM Group Underwriting Policy or BCN Group Underwriting Policy.