Many small business owners are unaware of the definition of what constitutes a small group in 2014.
This will encourage (O.K. force) business owners to consider options on or off the exchanges. Many small
Find out what's happening in Rancho Santa Margaritawith free, real-time updates from Patch.
groups were formed because of pre-existing conditions that prevented owners from obtaining individual
coverage. That is no longer an issue with pre-existing conditions eliminated in 2014.
Find out what's happening in Rancho Santa Margaritawith free, real-time updates from Patch.
I will try and clarify the underwriting guidelines from most insurance carriers that define a small group.
1. 1-50 eligible employees (instead of 2-50 currently)
2. Employer must employ at least 1 “common law” (W-2 employee)
3. The common law employee must also be an eligible employee
4. A sole proprietor must have 1, W-2 employee and that employee cannot be the spouse/domestic partner or owner
5. The employer must offer coverage to all eligible employees
6. At least 51% of the employees must be employed in California
7. Groups must meet all other underwriting guidelines such as contribution - minimum 50% of the employees cost for the lowest
premium plan offered, participation - minimum 70% of eligible employees. (eligible generally means the employee is not covered on a spouses plan or not covered by Medicare or Med-I-Cal) Through December 15, 2013 a group can obtain group coverage for January 2014 WITHOUT PARTICIPATION OR CONTRIBUTION REQUIREMENTS
If you have a Partnership, S-Corp, C Corp, or LLC, a group is defined as having 1, W-2 employee who works on average 30 hours per week. And that employee can be a spouse(s) of one or more of the owner (s) but the group must have at least one non-owner common law (W-2) employee.
Owner only groups are not eligible. However if the group has 1, W-2 employee the group then qualifies and the owners are eligible employees as long as they actively work in the business and the Insurance Company may still require owner documentation to prove that.
If you have questions please comment or contact me at 949-459-0012.
Colin Moore - Certified Agent - Covered California Health Exchange.
