Get a quote

Have questions about our plans, want to get a quote or need marketing materials? Our friendly and knowledgeable team members are here to assist you.

Call us Monday through Friday, 8:30 a.m. to 5 p.m. Pacific Time, toll-free at 800-578-1402. TTY users, please call 711.

Enrollment and underwriting requirements

Prepare your clients for a healthy start. Keeping your clients' population healthy is an investment that pays dividends. So, get ready to help start their journey to better overall health and wellness. Check out our quote checklist to see what information is required.

Business requirements

Here are some of the finer points about enrolling small groups in our plans.

• Group requirements: Must be at least 25+ enrolling only.
• Obtaining a quote: Requires member level census, renewal rates, claims experience and large claims (for groups with claims data), as well as the employer level risk questionnaire. Claims experience should be received within 120 days of the effective date.
• Service area: 60% of all employees must live, reside or physically work within the Moda Health service areas.
• Ineligibilities: 1099 employees and PEO's.
• Plan choices: A group of 25-99 can choose up to 3 plans to offer their employees. For groups of 100+, up to 4 plans may be offered.
• Employee participation: A group must have a minimum participation of 75% of full-time eligible employees (less valid waivers). There is no minimum participation requirement for dependents.
• Employer contribution: The employer must contribute at least 50% toward the employee only rate of the lowest cost plan. If a dollar amount contribution is chosen, the amount must at least equal 50% of the employee only rate of the lowest premium plan chosen.
• HRAs and HSAs: Rates assume no more than 50% funding of the employee/family deductible cost (HRA or HSA). For deductible plans without an HRA or HSA, the employee will be financially responsible for the funding of the entire deductible amount.

Stop loss

• Contract basis: Incurred in 12 months; paid in 60 months.
• Specific deductibles: Deductibles starting at $20,000.
• Aggregate attachment point: 120% of expected claims.
• Surplus share: 50% of surplus: The group must renew with Moda to be eligible for a surplus share.
• Account settlement: After 16 months, 50% of the surplus is paid to group via bill credit.

Moda retains 6% of the maximum annual claims fund as a terminal reserve for a settlement reserve for claims submitted during the remainder of the contract period (through the 60th month). The final settlement is issued after three (3) months of runout.

Questions?

We're here to help. Contact our Sales and Account Services team for friendly support.