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VISION UNDERWRITING GUIDELINES
SMALL GROUP
AETNA
AMERITAS
PRODUCT OFFERINGS
Product
Combinations
Single plan option.
(Same rates regardless of contribution/participation)
Dual Choice: Focus/Vision Perfect, or ViewPointe/Vision
Perfect. Available with 50+ eligible.
Triple Choice: Available to groups between 100-1,000 eligible.
Voluntary Product
Combinations
Same as above Product Combinations.
Same as above Product Combinations.
Network
EyeMed
Varies by plan: EyeMed VisionCare Access, EyeMed Select, VSP
Signature, & VSP Choice
Group Size
2-50 enrolling.
3–2,000. DE-9C not required.
Stand-Alone
Yes.
Yes.
Rate Guarantee
4 years.
24 months.
Admin Fee
None.
None.
Contribution
0-100% of employee cost.
Minimum 25% of employee cost.
Participation
Minimum 2 enrolled.
Minimum 60% of eligible employees. Employer may specify if
employees can waive when 100% ER contribution.
Voluntary Plan
Contribution
100% employee paid.
100% employee paid.
Voluntary Plan
Participation
Minimum 2 enrolled.
Minimum 3 enrolled.
Out-of-State
No maximum.
No maximum.
Carve-Outs
Union carve-outs are allowed with a minimum of 5 enrolled
employees who reside within the CA network service area; total
group population (union+non-union) must be 50 or less.
Available, rules may vary based on each groups demographics.
1099 Employees
Not eligible.
1099’s may be eligible, determined on the groups specific
demographics.
Owner Only Groups
Corporations: Eligible if there is at least one W-2 employee
enrolling in medical. If the only employees are owners and/or
spouses, and they are W-2, the group is eligible.
All other types: Not allowed. Must have at least one nonspouse, “common law” employee on the DE-9C and enrolled in
medical.
Allowed.
Industry Loads
None.
None.
Open Enrollment
Yes.
Yes; EE only. Section 125 plan is required. Open enrollment
must coincide with Section 125 election period. Load applies.
Dependent
Eligibility
Up to age 26.
Up to age 19 or up to age 24 if a full-time student.
ELIGIBILITY
Rev. Date 2/10/15
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VISION UNDERWRITING GUIDELINES
ANTHEM BLUE CROSS
CALCPA
PRODUCT OFFERINGS
Product
Combinations
Employer may elect single plan or dual option.
Single plan option.
Voluntary Product
Combinations
Employer may elect single plan or dual option.
Not available.
Network
Anthem Blue View
VSP Signature Network or VSP Choice Network
Group Size
2–50. DE-9C required.
2–50 eligible and enrolled. DE-9C required. Must be
headquartered in CA.
Available to accounting firms in public practice or firms
offering general financial services (SIC 8721). To be eligible,
more than 50% of all of the firm’s owners (principals,
proprietors, partners, shareholders, or other owners) must be
CPA members of CalCPA, or Associate members of CalCPA. All
CPA owners must be members of CalCPA in good standing.
Stand-Alone
Yes.
Must be written alongside medical.
Rate Guarantee
24 months.
12 months.
Admin Fee
None.
None.
Contribution
Minimum 50% of employee cost.
Minimum 100% of employee premium.
Participation
Minimum 75% of eligible employees.
If 100% employer paid then 100% participation required.
100% of eligible employees must enroll.
Voluntary Plan
Contribution
Less than 50% employer contribution; may be 100% employee
paid.
Not available.
Voluntary Plan
Participation
Minimum 10 enrolled.
Not available.
Out-of-State
49% maximum.
49% maximum.
Carve-Outs
Due to PPACA: Management vs. Non-Management Carve-outs
are not eligible.
Allowed with minimum of 5 enrolled.
Union/Non Union carve outs are guaranteed issue with 5
min enrolled only when the total group size with the Union
employees is 50 or fewer.
Not allowed.
1099 Employees
Not eligible.
Not eligible.
Owner Only Groups
A sole proprietorship is ineligible without a common law
employee. A spouse does not constitute a common law
employee (refer to employee eligibility requirements). Owners,
that are not spouses, may demonstrate that they meet the
eligible employee criteria by providing W-2s or completing the
Eligibility Statement.
Allowed, includes husband/wife groups.
Industry Loads
None.
None.
Open Enrollment
Yes.
Open Enrollment occurs once a year through Nov-Dec, and all
changes are effective January 1.
Dependent
Eligibility
Up to age 26.
Up to age 26.
ELIGIBILITY
Rev. Date 2/10/15
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VISION UNDERWRITING GUIDELINES
CALIFORNIACHOICE®
HEALTH NET
METLIFE
PRODUCT OFFERINGS
Product
Combinations
Single plan option; discount program.
Single plan.
Single plan.
Voluntary Product
Combinations
Single plan option.
Single plan.
Single plan.
Network
EyeMed
EyeMed
MetLife
2–50. DE-9C required.
2–50. Must have 2 enrolled.
DE-9C required.
5–50 Book Rated. Must be in business at
ELIGIBILITY
Group Size
least 1 year prior to the effective date of the
coverage.
DE-9C required for groups with more
than 50% family members. Groups with
less than 10 employees, no more than
75% of the group can be direct family
members
Employees age 65+ must be less than
20% of the group.
Stand-Alone
No.
Yes
5–9 enrolled: must be sold with dental.
10+ enrolled: must be sold with either
dental, life or disability.
Rate Guarantee
12 months.
12 months. Cases sold off cycle from
medical will have their first renewal in
conjunction with medical.
24 months.
Admin Fee
Fee based on group size:
2-8 employees: $20 per month.
9-20 employees: $25 per month.
21+ employees: $30 per month.
None.
None.
Contribution
N/A; Discount Eyecare Program included
Minimum 50% employee.
No minimum requirement.
Participation
N/A; Discount Eyecare Program included
for all members and dependents
Minimum 75% of eligible with at least 2
enrolled employees.
10% of eligible with a minimum of 5
enrolled employees.
Voluntary Plan
Contribution
100% employee paid.
Voluntary rates apply to group with less
than 75% participation and/or 50%
contribution ; may be 100% EE paid.
No minimum requirement.
Voluntary Plan
Participation
No participation requirement. Dependent
enrollment for voluntary vision does not
have to match dependent enrollment for
medical.
Voluntary rates apply to group with
less than 75% participation and/or
50% contribution. Must have at least 2
enrolled employees.
10% of eligible with a minimum of 5
enrolled employees.
Out-of-State
49% maximum. Out-of-state employees
considered Area 9 for rating purposes.
49% maximum.
Groups with more than 25% of the
employees residing out of state must be
custom rated.
Carve-Outs
Not allowed. Union employees are
considered ineligible.
Not available.
Allowed - Minimum 5 enrolled.
1099 Employees
Not eligible. Commissioned employees
must earn a base salary at least equal to
minimum wage to qualify.
Not eligible.
Not eligible.
Owner Only Groups
Not allowed. Must have at least one nonspouse, “common law” EE on the DE-9C.
Not allowed. Must have at least one nonspouse, “common law” EE on the DE-9C.
Allowed.
Industry Loads
None.
None.
None.
Open Enrollment
Yes, with medical.
Yes.
Included on all plans.
Dependent
Eligibility
Up to age 26.
Up to age 26.
Up to age 26.
Rev. Date 2/10/15
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VISION UNDERWRITING GUIDELINES
PRINCIPAL
UNITEDHEALTHCARE
VSP
PRODUCT OFFERINGS
Product
Combinations
May offer multiple plan combinations
based on defined job classes. May not
offer multiple plans where employees
can choose their plan selection.
Single plan only.
Single plan only.
Voluntary Product
Combinations
Same as Product Combinations above.
Single plan only.
Single plan only.
Network
No network. VSP Access Plan: discounts
offered through VSP.
UnitedHealthcare
VSP
Group Size
5+. DE-9C not required.
2–99. DE-9C not required.
2–300. DE-9C required for non-voluntary
plans with less than 10 enrolled EEs.
Stand-Alone
Yes
Yes.
Yes.
Rate Guarantee
12 months.
24 months.
12 months.
Admin Fee
None.
None.
$15 per month.
New groups of 2-4 enrollees: For the first
year, discounted to $10 per month.
Contribution
Employer Paid: 100%.
Contributory: Between 1-99%
Employer Paid: 75%–100% toward both
employee and dependent premium
Buy-up: 75%–100% toward employee
premium
50/50: 50%–74% toward employee
premium
100% of employee cost.
Participation
Employer Paid: 100% of eligible.
Contributory: Minimum 20% of eligible or
5 enrolled, whichever is greater.
Minimum 75% participation with at least
50% of total eligible regardless of valid
waivers
100% with a minimum of 2 enrolled.
Voluntary Plan
Contribution
100% employee paid.
0%–49% toward employee premium
100% employee paid.
Voluntary Plan
Participation
Minimum 20% of eligible or 5 enrolled,
whichever is greater.
Minimum 2 eligible and 1 enrolled.
Must have 2 enrollees.
Out-of-State
No set maximum, determined on a case
by case basis.
No limit.
No limit.
Carve-Outs
Allowed. Carve-out population must
meet minimum standard participation
guidelines.
Available with 5+ eligible and enrolling
employees. Eligible class descriptions
include: Salary/Hourly, Union/Non-Union
and Management/Non-Management.
Any type of carve-out is allowed such as
Union/Non-union, Management/Nonmanagement, Salaried/Hourly.
1099 Employees
Not eligible.
No more than 25% of the enrolled groups
can be 1099 employees.
Yes, if the 1099 employee is included in
the medical plan.
Owner Only Groups
Allowed.
Not allowed. Must have at least one
non-spouse, “common law” employee on
the DE-9C.
Allowed as long as owners are members
of the group and are involved in the day
to day operations of the group.
Industry Loads
None.
None.
None.
Open Enrollment
Included on all employer paid and
voluntary vision groups.
Yes.
Non-voluntary Plans: Yes, for unenrolled
dependents only.
Voluntary Plans: Yes, for unenrolled
employees & dependents.
Dependent
Eligibility
Up to age 26.
Up to age 26.
Up to age 26.
ELIGIBILITY
All information published herein is gathered from sources which are thought to be reliable, but the reader should not assume
that the information is official or final. Reliance on this information received from LISI shall be at your sole risk, and LISI assumes
no responsibility for any errors, omissions, or damages arising. Users of this information are encouraged to confirm with other
sources, and to seek qualified advice if embarking on any actions that could carry personal or organizational liabilities.
Rev. Date 2/10/15
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