In order to align with other carriers in the industry and based on federal guidance, Humana is updating their small group medical eligibility rules. Federal guidance requires that there be at least one employee enrolled under the medical coverage who is not an owner or the spouse of an owner (opposite sex or same sex).
IMPACT: These owner(s) or owner(s)/spouse(s) groups are not considered valid groups for the purpose of group health insurance, and should be referred to the individual market for coverage options.
- As of September 23rd, 2016, Humana no longer wrote groups consisting of only owner(s) or owner(s)/spouse(s). These cases should not be submitted.
- Cases submitted on or after 12/1/16, will require the Small Employer Attestation for Group Medical Coverage (link to attached) to be submitted for all valid groups that have 5 or less enrolling in the medical coverage. By signing this Attestation the group is validating that they fulfill the requirements of a bona fide group and are in accordance to the regulations stated within the Attestation.
- If the group is not enrolling in medical, this Attestation is not required.
- If the group is electing other lines of coverage alongside medical and cannot provide the signed Attestation, the entire case including the other lines will be withdrawn. If the group still wants us to proceed with the other lines of coverage, please notify SBSales@humana.com and the case will be reopened to be processed without the medical coverage.