Qualifying for a Small Group Health Plan
In order to comply with the Affordable Care Act, an employer must have at least one common-law employee enrolled to qualify as a group health plan. Businesses that do not have any common-law employees enrolled are no longer eligible for a group health plan and must be transitioned to individual coverage.
Sole owners/partners and their spouse are not considered common law employees regardless of whether they are listed on the quarterly wage report.
Beginning on October 24, 2017, groups we have identified as no longer qualifying for group coverage will receive a notification by mail.
- Please contact your account consultant if you would like a list of your impacted groups.
- Once you review the list and believe a group still qualifies for small group coverage, please contact your dedicated account manager to work with an underwriter on resolution.
- If a group does nothing, the group’s members will be automatically enrolled in an individual market plan similar to the plan they are in now.
- If a member wants to select another individual plan other than what they are mapped to, they will need to complete an application for the plan they wish to enroll in. Members can contact 1-888-576-6593 for assistance with Individual market plans.
- Members who are Medicare eligible will not be automatically enrolled in a plan. For help selecting a plan, they can call 1-800-671-6081 or visit excellusmedicare.com.
Alternate plan options can be found on our website under Individual & Families.