Group Insurance carriers over 50 California

[Guest llerner]

A client has roughly 80 EEs, 50% +/- have Kaiser HMO and the rest have a fully insured carriers PPO. Looking for an indemnity or PPO carrier to replace carrier PPO that does biz in CA that would accept Kaiser with no other HMO. Any help would be appreciated since both groups refuse to budge and they truly want to keep all happy.

[mroberts]

This would be pretty tough since most insurance companies' underwriting standards is to either insure all the employees or walk away. In certain instances where a group is split in half and in different states or completely different regions, carriers will look at the applicable groups and realize an all or nothing philosophy might night work, but these tend to be regional carriers only. BCBS, UHC, CIGNA, Aetna....all have nationwide networks, so they probably will not budge on their underwriting requirements, especially since the entire population is only 80 employees. If you have 8000, then you could probably negotiate something.

The pitch I would make to the two groups is simple - 50 tends to be the magic number when it comes to health insurance. Carriers will be more aggressive for these size cases, more markets open up, experience may be taken into consideration (if it's good it should slightly offset future increases), and more importantly, marketings down the road should be simplified since carriers usually only ask a generic group questionnaire rather than individual questionnaires when it comes to underwriting. As you probably know, if you go down the individual questionnaire road, it can be very difficult changing carriers if you have a couple sick employees or dependents. The group questionnaire doesn't totally eliminate this possibility, however, most of the time I've run into problems is when someone's dependent has some major illness that no one knew about and this is not always general information to the HR people.