I. New Jersey Small Employer Health Benefits Program defines an eligible small group employer as an employer with at least 1 to 50 eligible employees enrolling into coverage. Small employers must satisfy “participation” and “contribution” requirements in order to be eligible to enroll into a small group health plan.
II. An "eligible employee" is defined as working 25 or more hours per week and receiving at least minimum wage. Carriers may ask for proof of compensation for purposes of determining which employees are eligible for coverage and whether the employer meets the participation requirements.
Who is not considered an eligible employee:
• Owners, Partners, including spouses and children
• Sole proprietors
• 2% shareholders in S-corp
• Independent contractors - 1099’s
• Leased employees
III. Participation Requirements
At least 75% of the full-time employees must be covered under the health plan or covered elsewhere:
1. Coverage with another employer’s health plan
2. Coverage with a spouse’s employer health plan
3. Coverage with Medicare, Medicaid, Familycare, Tricare or GetCoveredNJ/Obamacare
Individual off-market health plans do not count toward the 75% participation requirement.
- Total Eligible:
- Total Enrolled:
- Total Valid Waivers:
- Participation: %
IV. Contribution Requirement
A small employer is required to contribute at least 10% of the total cost of the health plan’s premium. Employers can choose to
contribute a percentage amount or a flat dollar amount per employee.
Exception to the 10% Contribution & 75% Participation Requirement
Does not apply during the Employer Open Enrollment Period which takes place from Nov 15 through Dec 15.
V. Enrollment Requirements for a Small Group Health Plan
Employers can enroll their employees into a small group health plan on the 1st or 15th of any month. To enroll, the employer selects a carrier and health plan then they must provide the enrollment documents and meet enrollment eligibility criteria and requirements.
Small Group Health Enrollment Requirements:
* Group Enrollment Application
* Employer NJ Certification form
* Employee Enrollment Applications
* Waiver Forms
* Final Rates - signed
* Binder Check: Company check - 1st month premium
* AutoPay Form- recommended
* Business Tax forms: either K-1, Schedule C or 1120s showing 100% ownership
Required documents:
* WR-30
* C-Corps: Form 1120 pages
* S-Corp: Schedule K1 (From 1120s) or Schedule C
* Partnerships: Schedule K1 listing the names and ownership totaling 100%.
* New Hires: Most recent 2 weeks payroll journal/report and W-4
NJ Employer Certification
Carriers require an annual redetermination of small group eligibility by requesting you complete an NJ Employer Certification from and submit
supporting documentation. WR-30, waivers, either K-1, Schedule C or 1120.
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