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.

Christopher S. Kudryk
Insurance Specialist

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

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