Determining Small Group Eligibility
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
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.
- The FT enrolling employee must be non-family.
- 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...)