General Underwriting Guidelines

Business Verification

For all small group (6-50 employees) prospects and for renewal groups, proof of eligibility is required. 

Employer Contribution

HMO/POS/PPO Large Group (Greater than 50 employees)
The employer contribution must be at least 50% of the individual and the family rates, or 70% of eligible employees must participate in company sponsored health benefits AND the employer must contribute at least 25% toward the individual and family rates.

HMO/POS/PPO Small Group (less than 50 employees)
The employer contribution must be at least 50% of the individual rate. A minimum dollar value equal to 100% of the individual rate must be contributed towards the family premium. 

Participation Guidelines

1-5 Employees -
100 % of all employees in Health New England's enrollment area must enroll.
6-10 Employees -
75 % of all employees in Health New England's enrollment area must enroll.
11-50 Employees - 
Greater of 8 or 50% of employees n Health New England's enrollment area must enroll.
51+  Employees -
50 % of all employees in Health New England's enrollment area must enroll.

Enrollment Area Requirements 

HMO/POS/PPO At least 70% of the eligible and participating subscribers must live within the HNE enrollment area. HNE only markets within its service area.