Small Group Program

Governor Jennifer Granholm signed a legislative package that has changed the way the small group insurance market is regulated and marketed by health carriers in Michigan.  Public Act 88 is effective on January 23, 2004.

Terms you should be familiar with:

Small group

• Employer groups of 2-50 eligible employees regardless of geographic location

Eligible employees

• Law allows an employer to define an eligible employee as someone who works 17.5 hours or more per week
• Employers must consistently apply definition of eligible employee to all employee groups with company
• Eligible employees is the entire employee population less part-time, contracted or seasonal employees

Seeking coverage

• Defined the number of employees enrolling in an employer sponsored health coverage through their employer
• Excludes employees who have coverage through a spouse at another employer
• Excludes all opt outs

Participation rules

• Underwriting guidelines / requirements for enrollment established by a health plan

To comply with small group reform

Care Choices is offering the same benefit menu to groups with 2-50 eligibles, plus new generic requirement pharmacy riders.  Book rates are no longer available and rates are available by contacting Care Choices Business Support Center at 800-261-3452 or one of Care Choices General Agents (2-25).

Care Choices has adopted the following underwriting participation guidelines:

Group Size Participation Requirement 2-10 eligibles 100% of those seeking 11-25 eligibles 75% of those seeking 26-50 eligibles 50% of those seeking

Example 1

Jim’s Taxidermy has 47 employees on payroll plus 1 employee who is contracted and paid on via a 1099:

• Four are part time (not eligible)
• Jim has one contracted truck delivery driver (not eligible)
• Forty-three are eligible for health plan benefits
• Six employees have coverage through spouse
• Two employees don’t want to pay payroll contribution and opt out
• Thirty-five are seeking coverage
• The 50% participation rule applies

In the above example, at least 17 employees must enroll in Care Choices

Example 2

Turks’ Travel Agency has 65 employees on payroll (40 employees in Michigan, 10 in Ohio, and 15 in Illinois)

• Group does not fall under small group reform guidelines
• The group’s total employment size is used to determine if employer falls into the above criteria

Basic Plans with Deductibles

Benefit Plans and Pharmacy Riders - Group Size 2-50

2-25 Eligible Employees
Care Choices is now working with General Agents to assist agents with small business quotations. If you are an agent or new group with 2-25 eligible employees, please contact one of our General Agents to assist you.

When enrolling an employer group, please contact our Business Support Center for assistance at 1-800-261-3452. We'll be happy to answer your questions and walk you through the enrollment process.

Use our Enrollment Checklist to view a list of items that must be submitted to Care Choices to initiate the enrollment process for the small business program. Included in the checklist are links to documents that must be completed, signed and returned to Care Choices.