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
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.
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.
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