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Updates To Our Professional Employer Organization Guidelines

Excellus BCBS has made the following updates to our Professional Employer Organization (PEO) guidelines, allowing for more flexibility in the market for PEO business.

Beginning with groups effective January 1, 2023, a PEO may choose to insure co-employees in two ways:

  • As one group, insuring all co-employees through the PEO. The following guidelines apply to this arrangement:
    • PEO must be registered with New York State
    • PEO must be headquartered in Excellus service area
    • PEO must contract with employer groups to provide health insurance coverage – A copy of the standard contract language will be required.
    • Co-employees must live, work, or reside in Excellus service area
    • Co-employees must appear on the payroll/NYS-45 and 1095-c of the PEO
    • Group size is based on the total PEO Full-Time Equivalent (FTE) employees
    • PEO is solely responsible to ensure member groups are compliant with Federal and State health insurance regulations
    • All member groups must be written through the PEO health insurance policy
  • As individual direct groups, insuring each member group individually with the health plan. The following guidelines apply to this arrangement:
    • Group will be written independently with their own group number and insurance policy
    • All standard underwriting guidelines apply. All groups will be underwritten at initial enrollment
    • Group size is based on the FTE of the business being written
    • PEO must be able to provide a quarterly wage report or payroll for the business being written
    • PEO may choose to change to this structure one time. Structure changes will occur on renewal
    • All member groups must be written individually through the business by which they are employed

 

 
 
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