RESOURCE CENTER

Underwriting Guidelines
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AFA Paperless Process
aka, Automated New Business Submission Process. Attached is the new process - it clearly outlines all the steps needed to submit new small group AFA business as well as who is responsible for each item.
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AFA GRX census template
To be used for groups with 15+ enrolled and they wish to receive a firm AFA quote with underwriting based on Rx lookup. This census MUST be used.
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Aetna AFA Online Individual Medical Questionnaire (IMQ)
For firm rates, or if Long Form is required for Underwriting, you can setup your client online and have online IMQs issued to members for accuracy and convenience. Illustrative quote can be obtained, but rates will not be firm until IMQ is received.
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New Jersey Eligibility Guidelines Updated for 2014
Aetna revised UW guidelines for NJ, this releases advises of 3 changes due to ACA: 1) 75% participation, including waivers; 2) a group must have at least 1 W2 employee; 3) H/W groups are not allowed, unless have 1 W2 employee (spouse does not count).
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2014 NJ 51-100 Plan Guide
NJ Plan guide for all medical, dental, life, and DI plans sold in Mid-size group market (51-100 enrolled) beginning 2014. Includes Underwriting guidelines.
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2014 NJ 2-50 Plan Guide
NJ Plan guide for all medical, dental, life, and DI plans sold in small group market (2-50 enrolled) beginning 2014. Includes Underwriting guidelines.
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2014 PA 51-100 Plan Guide
PA Plan guide for all medical, dental, life, and DI plans sold in Mid-size group market (51-100 enrolled) beginning 2014. Includes Underwriting guidelines.
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2014 PA 2-50 Plan Guide
PA Plan guide for all medical, dental, life, and DI plans sold in small group market (2-50 enrolled) beginning 2014. Includes Underwriting guidelines.
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