Quote Information > Underwriting Guidelines

Hometown Health proposals adhere to the following Hometown Health Plan and Hometown Health Providers Insurance Company underwriting stipulations:

The medical premium rates quoted in the proposal assume that the employer group has an acceptable medical risk level based on Hometown Health Plan and Hometown Health Providers Insurance Company medical assessment standards. Hometown Health Plan and Hometown Health Providers Insurance Company retain the right to increase or decrease the proposed rates prior to a group's effective date, based on obtaining a medical risk assessment. Please Review the Medical Risk Assessment Process.

The Hometown Health Plan and Hometown Health Providers Insurance Company Underwriting Department will review the Medical Assessment Form(s) and advise the group as to the final rate determination prior to the effective date. Hometown Health Plan and Hometown Health Providers Insurance Company retain the right to decline a group of more than 50 employees.

If an employee and/or dependent medical conditions are not disclosed prior to the group's effective date, Hometown Health Plan and Hometown Health Providers Insurance Company retain the right to increase the initial contract rates at any time during the contract year retrospectively to the effective date.

1. Groups with 2-5 eligible employees are required to provide the following documentation prior to the group's effective date. (If the group is a new company, they will not be able to apply for coverage until they are able to provide the required documentation):
   Wage & Quarterly tax statement
   OR
   Business License AND Business Verification Form (obtained from Hometown Health)
   AND Schedule C (if the group is a sole proprietorship)
   
   
2. Groups with 10+ covered employees may offer a Hometown Health Providers Insurance Company Dental plan.
   
   
3. Groups with 2-25 covered employees may offer only a Hometown Health Plan HMO plan or a Hometown Health Providers Insurance Company PPO plan to their employees. No multiple options are available.
   
   
4. Groups with 26+ covered employees will be able to offer both a Hometown Health Plan HMO plan and a Hometown Health Providers Insurance Company PPO plan to their employees. Multiple options are available as long as both plans have 25% participation.
   
   
5. This proposal is contingent upon Hometown Health Plan and Hometown Health Providers Insurance Company being the only medical coverage offered by the group unless otherwise agreed to by Hometown Health Plan and Hometown Health Providers Insurance Company.
   
   
6. Seventy-five percent (75%) of all eligible employees must enroll in the employer's group health plan(s) and the group must have at least two employees enrolled to continue group health coverage.
   
   
7. The Employer must contribute a minimum of fifty percent (50%) toward the employee only monthly premium.
   
   
8. If the Employer contributes one hundred percent (100%) toward the employee-only monthly premium, then one hundred percent (100%) of the eligible employees must enroll.
   
   
9. Hometown Health Plan and Hometown Health Providers Insurance Company reserve the right to void or alter this proposal should the current employer contributions ($ or %) change prior to the group's effective date.
   
   
10. The proposal rates are based on the census information that was provided to Hometown Health Plan and Hometown Health Providers Insurance Company. Rates could change should the actual enrollment differ on the group's effective date.
    
    
11. Rates contained in this proposal are void after the effective date stated on the proposal.
    

Hometown Health Medical Risk Assessment Process

Please note the following requirements for employer groups applying for coverage through Hometown Health Plan and Hometown Health Providers Insurance Company, effective July 1, 2000.

Group will be effective no later than first of the month following 30 days from date of submission of completed Medical Assessment Forms.

• Employer groups with 51 or more eligible employees must submit a Group Medical Assessment Form. Hometown Health Plan and Hometown Health Providers Insurance Company retain the right to decline a group over 50 based on the medical risk assessment.
• Employer groups with 2-50 eligible employees must submit an original Medical Assessment Form for each employee and his or her dependent(s) eligible to enroll in the group's health plan. Hometown Health Plan and Hometown Health Providers Insurance Company retain the right to increase any proposed rates prior to a group's effective date, based on the medical risk assessment. The Medical Assessment Forms must be complete before being submitted to Hometown Health for review. Any forms lacking information will be returned to be completed and may delay the effective date of coverage for the group.

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