Small Group Eligibility
Small Group Health Plans:
To qualify for a Small Business health plan, the business must have at least 1 Fulltime employee enrolling in the policy. The FT employee must not be an owner or related to the owner.
The employee must work a minimum of 25 hours per week to be considered Fulltime and eligible for benefits.
Carriers no longer allow Group health plans to be issued solely to:
1) Owners-only groups
2) Husband/Wife groups
3) Family-only groups
Participation:
A group must meet the 75% participation requirement in order for the carrier to issue a group health plans.
75% of the fulltime employees must enroll or have valid health coverage elsewhere (ie. covered under a spouse, another job, Medicare, Medicaid, Obamacare, VA benefits).
- 8 out of 10 is 80% (Eigible)
- 6 out of 10 is 60% (Not eligible).
If the 75% participation is not met, the group health plan can not be issued or renewed. However, there is a Special Enrollment Period for small groups that allow groups to to enroll without meeting participation or contributions.
Upon Enrollment and Renewal:
Upon enrollment and renewal, employers are required to review your group's eligibility and participation levels. This is done by requesting the following:
- Employer Certification
- WR-30 payroll form
- Owners Tax forms
- Waivers
Special Election Period for Small Groups
November 15 - December 15.
Under the SEP, small employers are exempt from certain contribution and participation requirements for coverage effective January 1st.
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