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:
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:
Christopher S. Kudryk
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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