KBenefits Insurance Services
Group Health Insurance

Small Group Eligibility

Small Group Eligibility - Fully insured

Small Group Health Plans:
To qualify for a Small Business health plan the business must have at least 1 Fulltime Employee enrolling in the helth plan.  The FT employee must not be an owner or related to the owner. 


Fully insured carriers do not allow:

1)  Owners-only enrolling
2)  Husband/Wife-only groups
3)  Family-only enrolling


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.

Compliance - 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.

KBenefits Insurance Services
Health - Life - Medicare

Christopher S. Kudryk
Insurance Specialist

KBenefits Insurance Services provides insurance solutions for small business owners and individuals in New Jersey, New York, Pennsylvannia & Florida..

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