KBenefits Insurnace Services
Insurance - Medicare - Retirement

Small Group Eligibility

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


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.

KBenefits, LLC
Christopher S. Kudryk

KBenefits provides insurance solutions for small business owners and individuals in NJ & NY.  Contact KBenefits today and see how we can benefit you.

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