Determining Small Group Eligibility
Eligible Employee::
To qualify for a small business health plan, the business must have at least 1 fulltime employee other than the owner.. An eligible employee is an employee who works over 25 hours per
week.
Carriers require that a non-family, FT employee enroll on the policy. Owners can't be the only one enrolling.
Participation:
A group must meet the 75% participation requirement. 75% of the fulltime employees must enroll or have valid coverage elsewhere (ie. covered under a spouse, another job, Medicare, Medicaid,
Obamacare, VA benefits).
- 8 out of 10 is 80% (compliance)
- 6 out of 10 (not eligible).
If the 75% participation is not met, the policy can not be approved or renewed.
Upon Enrollment and Renewal:
Upon enrollment and renewal, employers are required to provide eligibility and participation paperwork for compliance review:
- Employer Certification
- WR-30 payroll form
- Owners Tax forms
- Waivers
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