What goes on a group health census (and what doesn’t)

A group health census needs four things for each employee: date of birth or age, home ZIP code, coverage tier and employment status. Names aren’t needed to get quotes, and neither are Social Security numbers, salaries or anyone’s health history. Covered dependents need ages too.

What does each field tell the carrier?

Date of birth or age

In most small group markets, each covered person is priced by age, and a family’s premium is the sum of its members. Ages drive the quote. A date of birth is better than an age, because the carrier uses each person’s age as of the plan’s start date, and a birthday between now and then can change the number.

Home ZIP code

In the small group market, rates are tied to your business address. Home ZIP codes still matter, because they show whether a plan’s network reaches where your employees live. That matters most for HMO and EPO plans, which usually cover care only inside a service area, and for anyone who lives in another state. Use home ZIPs, not the office’s.

Coverage tier

The tier is the level each employee expects to enroll in: employee only, employee and spouse, employee and child or children, or family. Mark anyone declining as a waiver. Note the reason, such as coverage through a spouse. Give each employee a number, and put that same number on a separate line for each spouse or child who will enroll, with that person’s date of birth.

Employment status

Mark each person full-time or part-time. Note whether they’re active, on leave or on COBRA, and give the hire date for anyone still in a new-hire waiting period, since that decides when their coverage can begin. Carriers use all of it to work out who is eligible and whether your group meets their participation minimum.

Our census template also has columns for each person’s sex and tobacco use, because carriers’ quoting systems ask for them. Fill those in too.

What does a finished census look like?

Say you have three employees. Employee 1 is 44 and wants family coverage, so number 1 gets four lines: the employee, a spouse and two children, each with a date of birth and the same home ZIP. Employee 2 is 29 and wants employee-only coverage, which takes one line. Employee 3 is covered through a spouse’s plan and gets one line marked as a waiver, with that reason. Six lines, three employee numbers, no names.

Expect to send a fresh census each time you shop the plan, including at renewal. Ages and headcount change every year, and a census from last spring can quote people who have left or miss people you’ve hired.

Why aren’t names needed?

Nothing about a name changes a quote. Carriers price from ages, location and tiers, and names only come in at enrollment, when each employee fills in their own forms with help from our step-by-step enrollment guides. Leaving names off also makes the file less personal while it moves between you, us and the carriers quoting it. An employee number or a job title keeps your rows straight.

What should stay off a census?

Leave these off:

• Names, if you’re only asking for quotes
• Social Security numbers
• Street addresses, since the ZIP code is enough
• Salaries, unless you also want quotes for life or disability coverage, which use earnings
• Anything about health: conditions, medications, pregnancies, claims or doctor visits

Federal rules let small group prices vary only by age, location, whether the coverage is for one person or a family, and, in some markets, tobacco use. Health history isn’t on that list, so it has no place on a census. Employees sometimes volunteer health details anyway. Don’t pass them along.

What are the most common census mistakes?

Most census problems show up in the same few places. Check each of these before you send yours:

1. Former employees still listed. Take them off unless they’re on COBRA.
2. COBRA members mixed in with active employees. List them, but mark them as COBRA, because a replacement plan generally has to cover people already on COBRA.
3. Part-timers given a coverage tier when your plan won’t make them eligible. Mark their status and leave the tier blank, or follow the carrier’s form.
4. Dependents listed wrong: a spouse who will stay on their own employer’s plan, a child who will be 26 or older by the start date, or a tier that doesn’t match the dependents listed.
5. Office ZIP codes in place of home ZIP codes.
6. Owners left off. If you or a partner will enroll, you belong on the census like everyone else.
7. 1099 contractors included. They aren’t employees for a group plan.

How do you send a census safely?

A census is sensitive, even without names. Dates of birth and ZIP codes together can identify people, so send the file through a secure upload rather than an email thread, keep it to the people in your office who need it, and delete old versions once quoting is done. The upload on our group health page takes an Excel or CSV file, and there’s a template there if you’re starting from scratch.

If you’d rather talk it through first, schedule a short walkthrough and send the census when it’s ready.

Quick answers

Can I send ages instead of dates of birth?

Yes. Give ages as of the date you want coverage to start, not today’s ages, so the quote reflects the ages the carrier will use.

Do employees who are waiving go on the census?

Yes, marked as waiving, with the reason. Carriers need them to check participation.

What if an employee’s family changes before the plan starts?

Update the census and send it again. A new spouse or child changes that employee’s tier and the quote.