Group Participation and Contribution Requirements
It is very important to meet participation requirements to avoid possible cancelation by the Health Insurance company.
- 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.
- 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.
- 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.
- 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.
- If the group contributes 100% of the premium, then all eligible employees must participate.
- 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.
- Large group health insurance dual options plans, may require at least 20% participation in each plan design.