You may not exclude from coverage any employee or a spouse
or a dependent child of an employee who meets your eligibility requirements.
The health insurance company or health plan may deny enrollment to one
or more of your employees and his dependents if they reside outside the
plan's service area as long as deny enrollment uniformly without regard
to health factors.
companies usually require that at least 75% of the eligible employees
of a small employer enroll in the group plan and at least 25% of eligible
dependents enroll in the plan where the employee is contributing a portion
of the premium for coverage. If the employer pays 100% of the premium,
then 100% of the eligible employees must enroll. The same rule applies
to dependent coverage if the employer pays the full premium. Employees
having other verifiable medical coverage on their own or coverage provided
by a government program are not normally included in the total number
of employees when applying these percentages.
company rules will also specify the minimum contribution an employer has
to make toward an employee's health insurance premium. Employers are generally
required to contribute at least 50% of the employee's portion of the premium,
but are not required to contribute toward that portion of the premium
attributed to the employee's dependent coverage. You can choose to pay
more and even cover all or part of the coverage for an employee's dependents
if you wish. If you pay 100% of the premium for employees, you are not
required to contribute to the cost for covering their dependents on the
health plan. You may also establish classes of employees and have different
contribution levels for each class, so long as you clearly define each
class and treat all members of a class in an equal manner.
will usually be required to certify that you meet the definition of a
small employer. You will usually be asked to fill out a health questionnaire
for the group. It is also beneficial to encourage your employees to maintain
healthy lifestyles as rates are usually based on the health of the employees
in a group.
insurance company usually imposes a 12-month preexisting condition limitation
on an employee who does not have prior health coverage and an 18-month
period for late enrollees, those employees who did not enroll in the plan
when first eligible. Credit toward this exclusion period is granted for
prior coverage without more than a 63-day break in coverage, not counting
an employer's probationary period. A timely enrolled child, adopted child,
or child placed for adoption would not be subject to a preexisting limitation
availability varies by the county and, in some cases, the zip code of
where your business is located.
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