Is your small group eligible for coverage?
Small Group Eligibility:
To qualify for a small business health plan, the business must have at least 1 Fulltime employee enrolling in the health plan. The FT employee must not be an owner or related to the owner.
Carriers can no longer enroll groups that have:
1) Owners-only enrolling
2) Husband/Wife-only enrolling
3) Family-only enrolling
Participation:
A group must meet the 75% participation requirement in order for the carrier to approve your group health plan.
75% of the Fulltime employees must enroll or have valid health coverage elsewhere (covered under a spouse, another job, Medicare, Medicaid, GCNJ, VA benefits).
- 8 out of 10 = 80% Eligible
- 6 out of 10 = 60% Not eligible
If your group is not eligible, see below.
Special Enrollment Period
Compliance: - Enrollment and Renewal
Upon enrollment and renewal, carrier's will review your group's eligibility and participation levels. This is done by requesting the following documents*:
- Employer Certification form
- WR-30 payroll form
- Owners Tax forms
- Waivers
Special Enrollment Period
November 15 - December 15.
Under the Special Enrollment Period, small business owners are exempt from the contribution and participation requirements. If approved, plans start January 1st.
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