Carrier recertifications during benefits renewal

What happens during a renewal audit, what's needed from your company, and what to expect.

When your company first applies for health insurance, the carrier will only approve your coverage if you meet certain rules, known as underwriting requirements. 

To make sure your company continues to meet their requirements, the carrier may request some information at renewal. This is known as a recertification audit. 

If your carrier notifies us of a recertification, we’ll complete as much of the paperwork as possible and continue preparing your renewal. A recertification typically does not affect the timing of your open enrollment. 

What’s needed from you

If we need information from you that’s not stored in Gusto (like ownership information or tax documents filed by your accountant), we’ll email your company’s benefits admins. Otherwise, we’ll move forward with preparing your renewal and let you know once the carrier approves the recertification. 

Renewal timing impact 

For most customers, recertification does not impact the timeline for plan selection and open enrollment. We can typically discover and process your recertification 1–3 months before your renewal date, at the same time we’re collecting your renewal information from the carriers. 

What the carrier might check for  

We’ll assess your carrier’s exact underwriting requirements and whether your company meets them, but here are some examples of what carriers may check at renewal. These may be different from the requirements your company had to meet when first applying for coverage. 

• Plan participation: To assess whether your company meets participation requirements, the carrier looks at the number of enrolled employees and employees with valid waiver reasons compared to the number of total eligible employees. 
• Ownership enrollment: The carrier may have specific rules if the only eligible or enrolled person is a company owner. 
• Employment status: The carrier may want to verify the number of hours worked by eligible employees.

What happens if your company does not pass recertification 

If the insurance carrier finds that your company does not meet their underwriting requirements during their recertification audit, they will not renew coverage.

However, your company is eligible to apply for coverage with any other insurance carriers. Your Gusto benefits advisor will reach out to your company’s benefits admins to walk you through your options and next steps to maintain coverage. 

Otherwise, we can show you different carriers you’re eligible for to make sure your team has coverage for the upcoming year.