Small Group Business Group Medical Questionnaire

Purpose of the Questionnaire

The Small Group Business Group Medical Questionnaire (SGBG MQ) is a standardized tool used by insurers, employers, and healthplan administrators to collect essential healthrelated information from members of small business groups. The data help assess eligibility, determine appropriate coverage levels, and facilitate underwriting decisions while complying with applicable privacy regulations.

Key Sections of the Form

1. Member Identification Name, date of birth, Social Security Number (or employee ID), and contact details.
2. Employment Information Employer name, group number, job title, and employment status.
3. Medical History Current health conditions, past surgeries, chronic illnesses, and ongoing treatments.
4. Medication Use Prescription drugs, dosage, frequency, and any overthecounter medications.
5. Lifestyle & Risk Factors Smoking status, alcohol consumption, physical activity, and BMI.
6. Family Health History Major illnesses in firstdegree relatives, such as heart disease, diabetes, or cancer.
7. Consent & Authorization Signature fields for the member and, where required, the employer.

How to Complete the Questionnaire

Follow these steps to ensure accuracy and a smooth processing timeline:

• Read each question carefully. If a question does not apply, write N/A.
• Provide current information. Use the most recent medical records and medication lists.
• Be truthful. Inaccurate answers can lead to claim denial or policy cancellation.
• Attach supporting documents. Include doctors notes, lab results, or specialist reports when requested.
• Sign and date the form. Both the employee and the authorized employer representative must sign.

Common Mistakes to Avoid

Privacy and Confidentiality

All information submitted through the SGBG MQ is protected under the Health Insurance Portability and Accountability Act (HIPAA) and any statespecific privacy laws. Data is stored on secure servers, accessed only by authorized underwriting staff, and retained only for the period required by law.

Members have the right to request a copy of their completed questionnaire and to correct any inaccuracies.

Frequently Asked Questions

1. Who must fill out the questionnaire?

Every individual applying for coverage under a smallgroup health plan, including dependents, must complete a separate questionnaire.

2. Can I submit the form electronically?

Most insurers provide a secure online portal where the questionnaire can be completed and uploaded. Paper versions are still accepted where electronic submission is not feasible.

3. How long does the review process take?

When the questionnaire is complete and all required documents are attached, most underwriting teams finalize their review within 710 business days.

4. What if I have a preexisting condition?

Preexisting conditions must be disclosed. Under the Affordable Care Act, smallgroup plans cannot deny coverage or charge higher premiums based solely on preexisting conditions, but accurate disclosure is still required for proper risk classification.

Sample Questionnaire Layout

Below is a simplified excerpt illustrating the layout of a typical SGBG Medical Questionnaire.

Next Steps After Submission

• Underwriting Review: The insurer evaluates the responses, requests any clarification, and assigns a risk rating.
• Policy Issuance: Once approved, a policy document is generated and delivered to the employer and employee.
• Onboarding: New members receive benefit cards, summary plan descriptions, and enrollment instructions.

Resources

• Centers for Medicare & Medicaid Services (CMS)
• HIPAA Guidance U.S. Department of Health & Human Services
• U.S. Small Business Administration Health Coverage for Small Employers