Q4 MEDICAL NEW BUSINESS SUBMISSION GUIDE
 
For Anthem, Oxford and Harvard Pilgrim New Business

The 4th quarter is here and the AmWINS team has been working closely with Anthem, Oxford & Harvard Pilgrim to develop a guide for Q4 Medical New Business Submissions.

Please review the following information for each carrier.

Requirements that apply to all 3 carriers can be found below the carrier-specific sections.
        
  • Business due to Anthem by the 20th
     
  • Please allow processing time by AmWINS to get to Anthem on time
     
  • Census is required for all submissions
    • Download the 2019 Census Template
      • "Waivers" tab must be completed
      • The 2020 Census Template will be released soon - continue to use the
        2019 census until the release of the 2020 version
          
  • All groups must submit the prior quarter UC5 with SSNs and wages visible
    • If there are any employees who do not appear on the UC5 or do not show full-time wages ($4,290 for the quarter effective 10/1/19), payroll documents be required. Payroll documents must contain the group's name and confirm two weeks of hours, wages, all deductions with a begin and end date. 
    • Owners not appearing on the UC5 must submit applicable Schedule C or K1. If there are multiple K1 owners, all K1s totaling 100% ownership must be submitted even if the member is not benefit eligible
       
  • Groups electing 4 or more plans must be submitted by the 15th of the month
     
  • Census is preferred for groups under 10 and required for group over 10
         
  • We are required to submit the new IDR form on behalf of both the broker and AmWINS
     
  • Please ensure your clients are signing two copies - one for each submission
  • Census is required for all submissions (Census required for enrolled employees. Waiver forms required for employees waiving coverage.)
REQUIREMENTS FOR ALL 3 CARRIERS
  • All carriers require clean and complete submissions. AmWINS provides a new sale checklist to assist with this process.
     
  • All carriers require reconciled tax documents on all OWNERS and employees.
     
  • AmWINS recommends case submission 15-30 days prior to effective date.
    • Q4 is especially busy, so avoid last day submissions that inevitably get your clients stuck in the processing bottleneck.
       
  • Incomplete submissions WILL cause delays in case approval and ID card distribution
To comply with carrier deadlines,  AmWINS recommends 
submitting  all new business 15-30 days prior to the effective date .