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FirstCarolinaCare Underwriting Requirements

UNDERWRITING REQUIREMENTS

  1. PURPOSE: Process to determine if client meets FirstCarolinaCare Insurance Company (FCCIC) coverage criteria.
     
  2. PROCEDURE: Qualifying Application Criteria
  • Business must reside in our service area
  • Business must be in operation for at least one year
  • Minimum Participation (Required Employee Enrollment)
    • 50 percent of “Net Eligible” employees for groups with less than 50 Employees
  • Net Eligible Employees = total full-time employees less full-time employees covered under other
    qualifying coverage (i.e. Spouse, Medicaid, Medicare, etc.)
  • Employer must contribute at least 50% of the employee single premium
  • Employees must be regularly scheduled to work at minimum of 30 hours per week
  • Benefits must be offered to all employees (30 hours or more per week)
  • All enrollees must be bona fide employees of the company or eligible dependents of such employees
    as defined in the Certificate of Coverage
  • Employer group must submit ESC Quarterly Wage and Tax statements upon application and as
    requested thereafter
  • Employer is responsible for making the payroll deductions for each employee
  • Each eligible employee must complete required forms
  • The effective date for new group coverage is on the first of the month
  • Premiums are due by the tenth of each covered month.
  • Group must agree to sign the Master Group Contract
  • If enrolling employee has different last name than dependents, proof must be
    submitted to verify relationship
  • The maximum waiting period for eligibility is 90 days
  • Employees who waive coverage because they are covered under another employer-based plan, or ERISA
    self employed plan, will not be included in the eligible employee count. Copy of ID card or waiver form
    is required.
  • No more than 10% of total eligible may be on COBRA or other self-pay status
  • Dual plan options available only with prior approval by carrier
  • Carrier must approve any self-funding of the deductible prior to the release of final rates