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Small business policy updates

Underwriting Guidelines for Brokers & Producers

Kaiser Permanente Small Group Underwriting Guidelines are updated twice annually. Review the policies below that will be included in the next update of our Underwriting Guidelines for Brokers and Producers (PDF).

Review the policies below

Change of sole proprietorship and single-member LLC documentation policy

Effective immediately, sole proprietors who apply for Kaiser Permanente small business coverage in California only need to submit a Schedule C tax form, also known as Form 1040, Profit or Loss From Business (Sole Proprietorship). They no longer need to submit a Form 1040, U.S. Individual Income Tax Return.

This change also applies to a single-member limited liability company (LLC):

  • That doesn’t choose to be treated as a corporation
  • Whose owner files a Schedule C

If you have any questions, please contact your Kaiser Permanente representative.

Help new small groups apply with relaxed payroll documentation

It’s now even easier to help your new small group startups and newly hired employees apply for coverage – even if they don’t have a DE 9C or payroll documentation yet. New small groups with 6+ enrolling subscribers aren’t required to submit a DE 9C or payroll documentation. Groups with less than 6 enrolling subscribers need to provide one or more of the following documents to account for all eligible employees:

  • DE 9C (quarterly report of wages). If a DE 9C is not yet available, 2 weeks of payroll showing one or more eligible employees will be accepted.
  • New Employee Eligibility Document (PDF). This form documents eligible employees NOT on the DE 9C who were hired in the last 45 days and can’t show 2 weeks of payroll.
  • Small Business Payroll Attestation (PDF). This form is used for new businesses (like a start-up, breakaway, or an existing business that’s establishing payroll) to document eligible employees. Groups are required to submit 30 days of payroll within 45 days of their effective date.

Note: A DE 9C is required for groups undergoing recertification.

Extended: Relaxed DE 9C policy

Small groups don’t need to submit a DE 9C if they have 6 or more enrolling employees with Kaiser Permanente. Groups that qualify will have to submit a recent DE 9C during the recertification process.

Small groups with effective dates through January 1, 2020, don’t need to submit a DE 9C if they have 6 or more eligible employees enrolling with Kaiser Permanente. Groups that qualify for this promotion will have to submit a recent DE 9C during the recertification process. 

Policy on subscriber terminations

Our policy on subscriber terminations states that all subscriber terminations will be effective in the month that we receive the termination request, unless you request that the termination be effective in a future month. We will not retroactively terminate subscribers prior to the month we receive the request to terminate. For example, if you want the subscriber’s coverage to be terminated beginning August 1, we must receive the request to terminate no later than August 31. A termination request received in August cannot be made effective retroactively back to July 1 or June 1.

You can still retroactively add new members to coverage up to two months before the first day of the month you notify us. For example, you could retroactively add a member as early as August 1; if we receive your notification by September 30.

For more information, download our Subscriber Termination Policy Q&A. (PDF)

 
 
 
 
 
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