|
The rules tell you how to determine who is an eligible employee for
health insurance purposes. You are given flexibility in determining
the number of hours worked per week for an employee to be considered
full time and eligible for health insurance.
The minimum requirement customarily established by insurance companies
is 20 hours per week; therefore you can choose any hourly requirement
between 20 and 30 hours. You are also given flexibility in determining
a probationary period or waiting period for newly hired employees.
You may not exclude from coverage employee, spouse, or 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 they deny enrollment uniformly without regard to
health factors.
Insurance companies usually require that at least 75% of the eligible
employees of a small employer enroll in the group plan. If the employer
pays 100% of the premium, then 100% of the eligible employees must
enroll. 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.
Insurance 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.
You may be required to certify that you meet the definition of a
small employer. You will be asked to have your employees fill out
an individual health questionnaire. 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.
The insurance company usually imposes a 12-month pre-existing
condition limitation on an employee who does not have prior health
coverage. Credit toward this pre-existing limitation 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 period. A 12 to 18-month
combination exclusion and pre-existing limitation period can be
imposed for late enrollees, those employees who did not enroll
in the plan when first eligible.
If you do not find the information you need here, please use
the "Have Us Help You Decide" button at the top of this page to let us know.
|
