Carrier News

Humana to Change Underwriting Process for 10-100 Life Groups

Beginning 7/1 for quotes effective 9/1/2018 and later, Humana will change how they underwrite risk-rated groups with 10-100 lives. Currently, Humana requires individual health statements and/or claim reporting, depending on circumstance.

Using a proprietary Risk Analytic Engine they built, which compiles health history and utilization data, Humana will research the risk of each member on the census. They will use the collective risk score to apply their underwriting adjustment. The platform is not Milliman’s GRx solution—a popular third-party underwriting engine used by many of Humana’s competitors.

They will use it to underwrite the following groups.

  • Level Funded quotes for employers with 10-99 enrolled subscribers.
  • Mid market fully insured quotes for employers with up to 99 enrolled subscribers.

They will not use the Risk Analytic Engine to underwrite these groups.

  • Small group fully insured quotes. The plans are community rated and cannot be underwritten.
  • Level funded quotes for employers with less than 10 enrolled subscribers. They will continue to use individual health statements.
  • Large group fully insured and self-funded quotes for employers with 100+ employees. They will continue to use traditional underwriting methods including claim reporting.

Please use our Benefits RFP or large group census workbook linked on our Quote Requests page for a complete list of documentation requirements for underwritten quotes.

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