Small group renewal
Renewing a small group has 2 parts:
Renewing a small group with Medicare coverage? See information about when to submit group notices.
Pre-Renewal Certification process
Through this process, we ensure every group (or subgroup*):
- Complies with all participation rules
- Does not exceed 20% early retiree/retiree/surviving spouse participation
- Stays within the guidelines for out-of-area enrollment
- Verifies all employees enrolled in the plan are eligible W2 employees or owners
- Meets all Group Agreement requirements
*If your group has subgroups, each subgroup is considered a separate legal entity and will have to complete this process individually.
Required information
All groups will need to provide or fill out:
- Quarterly Wage Detail Report (QWDR) - Should be the group's most recently filed QWDR.
- Pre-Renewal Certification form - Be sure they include their premium contributions per employee. Get the Pre-Renewal Certification form now (18KB PDF).
- Certification of Owner form - Only if the group's owner is not listed on the QWDR or if the QWDR shows less than full-time wages for the owner(s). This form must be notarized to be accepted. Get the Certification of Owner form now (18KB PDF).
- Employee waiver forms - Required for all eligible employees seeking coverage for the current plan year. Download an Employee Waiver form (32KB PDF).
- Enrollment forms or termination (change forms) - Only if the group doesn't meet the minimum employee participation rules or eligibility requirements. Download an Enrollment form (764KB PDF) or a Change form (used for termination of coverage) (514KB PDF).
Communications
What you and your clients can expect during this process:
- 120 days before renewal date: You will receive the pre-renewal packet (pre-renewal letter and required documents) via email 7 days before your group gets it.
- 113 days before renewal date: Your group will receive the pre-renewal packet (pre-renewal letter and required documents) via the mail. The letter will provide the current contact name and email address on file. If incorrect, the group can update the information on their pre-renewal certification form. See a copy of this letter. (568KB PDF)
- 90 days before renewal date: We'll send a follow-up email to groups that haven't sent their information or sent incomplete information. Groups with no valid email address on file will receive their letter via U.S. mail. We'll email you a copy. See a copy of this letter. (542KB PDF)
- 30 days before renewal date: We'll send a certified letter to groups that haven't sent information or sent incomplete information. This is the 30-day notice of termination. We'll email you a copy. See a copy of this letter. (540KB PDF)
Note: Make sure you and your groups have a valid email address on file so you and they receive all correspondence. You must be logged-in to see all sample letters.
What your emails look like
Your email notices will contain a copy of the letter sent to your group with all required documents attached. The letter will be embedded in the body of the email, so you may need to scroll down to see it.
Completing the process
We'll send a confirmation email to you and your client once we receive all required information.
Incomplete information
Groups who don't submit the required information, or who submit only part of the information, will receive the follow-up letter. The letter will include the status of each required document, so the group (and you) will be able to clearly see what has been submitted and what hasn't.
If we still don't receive all required information at 30 days before renewal, we'll send a notice of termination letter via certified mail. The group's coverage will end at 11:59 p.m. on the day prior to their renewal date.
Renewals in ClientManager
You can get your small group's renewal paperwork and start renewal quotes in ClientManagerSM about 90 days before their renewal date, even if they haven't yet completed the pre-renewal certification process.
However, a group must meet prerenewal certification criteria to be renewed and for their renewal rates to be valid.
Renewal Verification Form (RVF)
- Groups must submit a signed RVF at least 30 days prior to renewal whether or not they're making benefit changes.
- We send a reminder letter to groups 45 days before renewal if we haven't received a completed, signed RVF.
- See a sample of the reminder letter (523KB PDF).
Note: Submission of an RVF is required and is not part of the Pre-Renewal Certification process. It's a separate, additional form.
Group Medicare plan renewals
Submit group Medicare renewal notices to Priority Health 60 days before the group's effective date. This ensures we will meet the Center for Medicare and Medicaid Services (CMS) requirement that we send members their Annual Notice of Change (ANOC) 15 days before their open enrollment period.
