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

 

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.

KBenefits, LLC
Christopher S. Kudryk
chris@kbenefits.com
732-333-1976

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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