Insurance - Medicare - Retirement

Small Group Eligibility

Determining Small Group Eligibility


Participation:   A group must meet the 75% participation requirement.  Meaning, 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%  (good)  / 6 out of 10 (not eligible).  If 75% participation is not met, a policy can not be approved.



Eligible Employee: In order to enroll in a small group health plan, the business owner has to have at least 1 fulltime employee listed on the WR-30 payroll form.  An eligible employee is considered an employee who works over 25 hours per week.  With this scenario, both the employee and owner can enroll in a small group health plan with either Horizon BCBS, Amerihealth, Oxford or Oscar if they meet the following criteria:

  • Owners can't be the only ones enrolling.
  • Non-Family:  The FT enrolling employee must be non-family.
  • Thus husband/wife groups are not eligible since they owners and/or related to the owner.

If you fall under this category, contact me.  I have other group health insurance options to consider.   (ie. association plans, mewa, self-insured, etc...)



Upon Enrollment and Renewal:   Partipation/Compliance check:   Upon Enrollment and Renewal, carriers are required to confirm eligibility and participation compliance by small group employers submitting the following documents for review:

  • Employer Certification
  • WR-30 payroll form
  • Owners Tax forms showing 100% ownership
  • Waivers


KBenefits, LLC
Christopher S. Kudryk
Call:  732-333-1976
Fax:   732-444-5971



Chris Kudryk
NPN: #7990501


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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