KBenefits Insurance Services
Group Health Eligiblity

Small Group Health Eligibility

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


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.

YouTube version:   https://youtu.be/5ulbCqzRSkM

Contact us for advice, navigation, plan options & free enrollment assistance.

Christopher S. Kudryk

KBenefits Insurance Services
Health, Dental, Vision, Life,
Medicare & Retirement Income Policies


Christopher S. Kudryk
Insurance Specialist

KBenefits specializes in health, dental, vision, life and medicare insurance for employers and individuals in NJ & NY.

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