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Group Participation and Contribution Requirements

It is very important to meet participation requirements to avoid possible cancelation by the Health Insurance company.

  1. Large groups (51+ employees) minimum participation requires the greater of 75% percent of employees or 50 percent of total eligible employees. Review your certificate of coverage for health insurance definition of “net eligible” employees.
  2. Small group (2-50 employees) minimum participation requires enrollment of at least 75% of the “net eligible” employees . Every carrier may have a slight variation on the definition of net eligible. All full time employees must complete applications even if they are waiving coverage or in their waiting period. A minimum of 2 employees must be enrolled in the group health insurance to qualify as a group plan. This included husband and spouse companies.
  3. Total eligible employees are the sum of all eligible employees. Net eligible employees are the total eligible employees minus those eligible employees with a valid waiver of coverage. Coverage through a spouses group health plan.
  4. Minimum employer contribution is at least 25% of the total cost for the health insurance coverage. At least 50% contribution for the employee only coverage.
  5. If the group contributes 100% of the premium, then all eligible employees must participate.
  6. For dual choice group health plans, the employer usually needs a minimum of 10 employees electing coverage. There needs to be at least 2 employees on each plan. Some health insurance plans may have different compliance standards, so always revert back to the certificate of coverage for the group health plan.
  7. Large group health insurance dual options plans, may require at least 20% participation in each plan design.