Health Net Small Business Group – Underwriting & Update

Bedrosian & Associates, your employee benefit specialists, want to share the following Health Net updates with you since these are the most commonly asked questions we have received.

What you need to know about Health Net Underwriting:

  • Mix and match all HMO and PPO plans, regardless of metal tiers
  • Groups of 1 to 5 eligible employees are required to have 70% participation with Health Net, and groups with 6 to 50 eligible employees are required to have 50% participation with Health Net. Same applies if the group is writing alongside Kaiser.
  • Newly Established Groups of 1 to 5 enrollees must qualify through 50% of prior calendar quarter test to be considered eligible for coverage.
  • Groups of 6 or more enrollees must be in business for at least 6 weeks to be eligible for coverage.
  • All plans can be wrapped
  • Groups currently in PEO arrangement are eligible for Health Net Small Business Group coverage. We can use the PEO payroll or PEO DE9C to establish their eligibility for coverage.
  • Owner only or Husband and Wife groups must have at least 1 non-owner, non-spouse W2 full time employee for at least 50% of the prior calendar quarter to be considered for coverage.
  • No carve out groups
  • No 1099s
  • No seasonal/temporary/substitute employees
  • Groups that leave Health Net previously no longer have to wait 12 months to return to Health Net

NETWORKS – Everything you need to know about Health Net Networks

  • All new 2014 Small Group HMO plans use WholeCare HMO network. Sutter, Health, Brown and Toland and Alta Bates Medical Group are excluded from the WholeCare HMO network.
  • PPO is FULL NETWORK. It is inclusive of Sutter Health (i.e. Palo Alto Medical Foundation, Mills Peninsula Medical Group), Brown and Toland, UCSF and Stanford Medical Group.
  • Out of state employees, PPO employees traveling to another state, or PPO dependents going to school in another state will use First Health Network
  • Mental Health and Substance Abuse facilities – you are able to locate in network facilities by selecting “other facilities” under the provider search dashboard.  

In all instances, Health Net Silver PPO rates is within the range of the competitor’s Bronze PPO plans, while Health Net Gold PPO is within the range of the competitor’s Silver PPO plans. Health Net has the BEST Platinum PPO pricing statewide, and in some instance, beating the competitors’ Gold PPO plans.


Submit a Comment

Your email address will not be published. Required fields are marked *