Small or Large? Determine Your Client's Size
The medical carriers no longer count how many employees are eligible for the benefits, nor do they count how many enroll in the medical plan when deciding how a group should be rated.
Instead, the carriers use the group's Total Average Employee (TAE) count to determine whether a group is rated as a small employer (2-50) or a mid/large employer (51+). Any Pennsylvania group that has employed, on average, 51 or more employees during the preceding calendar year will be considered a large employer for the purposes of rating.
The ACA defines an employee as any person for whom the company issues a W-2, and this includes full-time, part-time and seasonal workers who may or may not have been eligible for the employer's medical plan. This does not include 1099 independent contractors.
If you are uncertain as to how your client should be rated, have them complete the Employee Count Form provided below.
- Employee Count Form (excel)
- Employee Count Form (PDF)
Small Employer Quote (2-50 TAE)
Due to the changes from the Affordable Care Act, you will now need to provide a member level census containing the demographics of ALL enrolling subscribers and dependents in order to obtain health insurance proposals for your clients.
In addition, you will also need to capture "tobacco / non-tobacco" on the census.
| Member Type | Name | DOB | Gender | Coverage | Zip Code | Tobacco? |
|---|---|---|---|---|---|---|
| Employee | John Smith | 04/10/1968 | M | Family | 15222 | Yes |
| Spouse | Jane Smith | 07/25/1969 | F | 15222 | No | |
| Dependent | Matt Smith | 10/25/2003 | M | 15222 | No | |
| Dependent | Mary Smith | 08/17/2006 | F | 15222 | N |
We've modified our Group Quote Request Form to assist you with capturing the proper data. Both Excel and PDF versions are available for download by following the links below.
Please note, while both versions are acceptable; the excel file is recommended. Due to the increased volume associated with the now larger censuses, our standard turnaround times could be impacted when submitting a hand-written, PDF version.
-
2020 Group Quote Request Form (excel) (Revised February 2020)
Large Employer Quote (51+ TAE)
Quote Request Forms
- Aetna 51-100 Quote Request Form (51-100 TAE)
- Aetna 101+ Quote Request Form (101+ TAE)
- Group Medical Questionnaire (excel)
- required for groups with less than 200 employees or without claims experience.
- Individual Medical Questionnaire
- required for each employee if group has less than 25 enrolled
- Member-Level Census - for groups with less than 200 enrolled
- Member-Level Census Template (excel)
- Employee-Level Census - for groups with over 200 enrolled
- Employee-Level Census Template (excel)
Additional Information
- Current rates & renewal offer on carrier letterhead
- Benefit grid(s)
- If group currently has an HRA, provide the funding arrangement
- Current Invoice
If group has 100+ enrolled, the following information must also be provided:
- Claims Information
- Two years of monthly medical claims experience and matching enrollment.
- Detailed large claim infomration (include diagnosis, prognosis and costs)
- Incumbent carrier renewal calculation
Quote Request Forms
Census Information- Employee-Level Census
- Employee-Level Census Template (excel)
Additional Information
- Current rates & renewal offer on carrier letterhead
- Benefit grid(s)
- If group currently has an HRA, provide the funding arrangement
- Current Invoice
If group has 100+ enrolled, the following information must also be provided:
- Claims Information
- Two years of monthly medical claims experience and matching enrollment.
- Detailed large claim infomration (include diagnosis, prognosis and costs)
- Incumbent carrier renewal calculation
Quote Request Forms
Census Information- Employee-Level Census
- Employee-Level Census Template (excel)
Additional Information
- Current rates & renewal offer on carrier letterhead
- Benefit grid(s)
- If group currently has an HRA, provide the funding arrangement
- Current Invoice
If group has 100+ enrolled, the following information must also be provided:
- Claims Information
- Two years of monthly medical claims experience and matching enrollment.
- Detailed large claim infomration (include diagnosis, prognosis and costs)
- Incumbent carrier renewal calculation
Quote Request Forms
Census Information- Member-Level Census - for groups with less than 350 enrolled
- Member-Level Census Template (excel)
- Employee-Level Census - for groups with over 350 enrolled
- Employee-Level Census Template (excel)
Additional Information
- Current rates & renewal offer on carrier letterhead
- Benefit grid(s)
- If group currently has an HRA, provide the funding arrangement
- Current Invoice
If group has 100+ enrolled, the following information must also be provided:
- Claims Information
- Two years of monthly medical claims experience and matching enrollment.
- Detailed large claim infomration (include diagnosis, prognosis and costs)
- Incumbent carrier renewal calculation
Quote Request Forms
Census Information- Employee-Level Census
- Employee-Level Census Template (excel)
Additional Information
- Current rates & renewal offer on carrier letterhead
- Benefit grid(s)
- If group currently has an HRA, provide the funding arrangement
- Current Invoice
If group has 100+ enrolled, the following information must also be provided:
- Claims Information
- Two years of monthly medical claims experience and matching enrollment.
- Detailed large claim infomration (include diagnosis, prognosis and costs)
- Incumbent carrier renewal calculation