Who Is Eligible for Group Health Insurance?

December 14 | 2021
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Running a small business requires a lot of time and effort to ensure that you are profitable and that your employees (and yourself) are well taken care of. Health insurance is not likely at the top of your To-Do list, but it should be! Figuring out whether or not your business is eligible for group health insurance is essential if you want to enroll with good rates and adequate coverage.

In general, most businesses need to have at least one employee who is full time and is not the business owner in order to be eligible to sign up for group health insurance. However, there are other requirements that may have to be met, and much of it depends on factors including your business type, the status of your employee or employees and how much of your workforce you can get to participate.

The Basics of Group Health Insurance

Small companies that want to provide health care coverage for their employees often choose to sign up for group health insurance, a lower-cost option that helps both employer and employee. Federal law guarantees qualified businesses the option to sign up for this type of insurance, also called small group insurance, if they choose to do so. In addition, plans that are ACA-compliant (Affordable Care Act) cannot deny coverage to small businesses based on the health of their employees.

Unlike individual health insurance plans, group health insurance typically offers lower rates and better coverage. The insurer’s risk is spread across multiple participants, allowing for better premiums, which are also often split between the participating organization and its employees.

Eligibility Requirements

According to the ACA, a small business is between one and 50 employees. As mentioned above, your small business must have at least one full-time employee who is not the owner or spouse to be eligible for group insurance. An employee is considered full time if he or she works at least 30 hours per week.

In addition, a company must also be registered as a legal business entity in the state in which it does business. Different states have different business regulations, so it is important to find out if your business has completed all eligibility requirements.

In some cases, insurance companies may require that a certain percentage of your workforce participate in a group insurance plan for you to be eligible. Some states also require that employers contribute a certain percentage of the monthly premiums for their employees, typically about 50%.

Is Your Business Eligible?

If you think your business may be eligible for a group health insurance plan, contact Fringe Benefit Analysts. We can help you determine which plan is right for you and your employees, and we can go through state-specific eligibility requirements to make sure everything is in place before you sign up. We partner with several Utah group health insurance companies to help you get the best coverage possible for your employees at the best cost.