To get a large group on board with Priority Health
Contact our Agent Help Line or your region's sales representative to request a large group proposal. A Priority Health representative will gather information to
prepare your proposal.
See the self-funded renewal process or the
fully funded renewal process to renew a large group's coverage.
For more information about large business groups, jump down to:
Large group enrollment requirements
The group must:
- Be of a permanent nature and financially stable
- Have been formed for a purpose other than to secure
group insurance
- Carry Worker's Compensation coverage unless not required
by law
- Join or be a member of an organization recognized by
Priority Health or any Chamber of Commerce in the Priority Health service
area
- Not offer another employer sponsored individual plan if it violates our underwriting criteria
Eligible employees
- Eligible employees include ALL active employees who work a minimum of
20 hours per week.
- Seasonal employees, directors, corporate officers, trustees, corporate
lawyers, and owners or partners MUST be full-time
employees to be eligible.
- Members who are eligible for Medicare (or any governmental benefits)
will be treated as if they are enrolled in Medicare Parts A & B when
Priority Health benefits are applied.
Fully funded - community rating
Priority Health uses industry factors, age, sex and family size in
rating its large group products.
- We use the group's Standard Industry Classification (SIC) code and the
group's census of employees.
- Plans can be designed to fit the specific needs and requirements of
your client.
Fully funded - experience rated (PPO only)
For its
PriorityPPO product, Priority Health uses a common calculation method for pricing medical insurance products that has a
history of successful prediction.
First, we calculate
PriorityPPO manual rates using product-specific
base rates:
- Base rates are developed annually based on historical claims data for
the plan.
- Actuarially developed factors are used to adjust for the group's actual
age/sex mixture, geographic area, average family size and industry.
- Reform groups will use age-only factor and group size factor.
Additional minor factors are used in limited circumstances.
- These calculations result in the PriorityPPO manual
rates.
Then, for larger groups with 75 or more insured lives:
- Our underwriters use at least 12 months claim history along
with demographics, trend factors and a plan change factor to estimate
future claims and arrive at an experience-based premium requirement.
- Large claims are removed above a pooling point.
- These calculations result in experience-based premium
rates.
- The experience-based premium rates are then blended with the manual
rates to yield final PriorityPPO rates for the group.
Self-funded group rating
Priority Health administers several administrative services
only (ASO) products.
- We use prior claims experience, age, sex, family size and industry
factors to arrive at competitive reinsurance coverage for your
clients.
- Our extensive network of health care providers and portfolio of managed care services are important
components of these products.
- We offer COBRA administration at a minimal charge through COBRA
Compliance.
- See the Products section of this
manual for a listing of ASO products.
Billing structure
Each group is required to sign a Group Agreement with Priority Health and will be billed monthly.
See the Billing & Payment
section of this manual for more information.
Last modified
06/23/08
