Medium and Large Groups Health Insurance

If you are an employer with fifty or more employees you are considered a Large employer in the State of Idaho. Unlike Small Group reform, Insurers offering coverage to groups of 50 or more are not required to:

-provide desired coverage to any Employer Group that submits a request.
-restricted as to the premiums they can charge a particular group.
-limited on how much they can increase your rates each year.

How does an insurer set my group rates?

Although you are considered Large Group if you have in excess of fifty employees, carriers generally separate large groups into Medium and Large.

Medium Sized Groups: Group from 51 to 100 Employees are generally treated differently than large employer groups of 100+. The process of underwriting medium sized groups is similar to small groups wherein the insurance carrier generally has a series of health questions that each of your employees must complete. Generally referred to as a simplified health application or questionnaire, they are less in depth than small employer applications regarding the questions they ask, but are none the less necessary to get firm quotes. As such, the process is much the same as with Small Group insurances and Iapp also helps our medium sized clients simplify this process significantly.

Once a prospective carrier has received this data they will generally mix your individual health risk situations with their companies own rate pool experience. This mixture may vary from company to company but is ultimately what is used to establish a rate for your group.

Large Groups: Groups in excess of 100 employees are generally not require to obtain health information from individual employees. Most carriers will, however, require the employer to complete a questionnaire that asks for any significant health risks that are known by the employer at that time. In addition to this requirement, carriers will ask for historical claims information on the group collectively. Employers of this size can and should be receiving claims reports from their current carriers showing exactly how much the carrier has paid in benefit payments. Generally referred to as “Paid Claims Reports”, these reports, when combined with other important data, helps a prospective insurers competitively compete for your business.