Carrier Eligibility Requirements

Updated July 15, 2025 13:00

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Minimum Carrier Requirements for Medical Plans

If your company is newly offering medical plans through Justworks, please note that minimum carrier requirements apply. These requirements are evaluated on a rolling monthly basis. Participation in health insurance through Justworks is dependent on meeting all carrier-specific eligibility criteria, which are outlined in each carrier’s section below.

If your company does not meet the minimum requirements by the time health insurance renewals occur each fall, you may not be able to renew your plans for the upcoming plan year.

Already enrolled?

If you're an existing customer and have questions about eligibility at renewals, feel free to contact our support team for assistance.

Master Policy Plans (PEO) Carrier Eligibility Requirements

Aetna

At this time, for a company to provide access to medical insurance for their employees through Justworks, they must:

Have a minimum of 2 eligible employees from different households enroll
Have a minimum of 40% of benefits-eligible employees enroll (regardless of waivers)
No more than 10% of the company’s enrolled employees can be on COBRA (e.g., if 19 enrollees, only 1 can be on COBRA because 2 or more on COBRA would be over 10%)
If a controlled group is starting medical benefits at the same time (i.e., all entities share the same medical insurance start date), they may meet eligibility requirements collectively, as long as they have been underwritten together. This means they must offer the same medical plans and have identical medical insurance rates across all entities.
The company must have at least 1 W-2 employee to be considered eligible (this means that the entire company cannot be composed of only unpaid owners)

Please note that these minimum eligibility requirements do not apply to Aetna Vision or Dental insurance policies.

Kaiser Permanente & Aetna

At this time, for a company to provide access to medical insurance for their employees through Justworks, they must:

Have a minimum of 2 eligible employees from different households enroll
Have a minimum of 40% of benefits-eligible employees enroll (regardless of waivers)
No more than 10% of the company’s enrolled employees can be on COBRA (e.g., if 19 enrollees, only 1 can be on COBRA because 2 or more on COBRA would be over 10%)
If a controlled group is starting medical benefits at the same time (i.e., all entities share the same medical insurance start date), they may meet eligibility requirements collectively, as long as they have been underwritten together. This means they must offer the same medical plans and have identical medical insurance rates across all entities.
The company must have at least 1 W-2 employee to be considered eligible (this means that the entire company cannot be composed of only unpaid owner)s.

As a reminder, Kaiser Permanente must be offered alongside Aetna or UHC. This means the criteria described above apply across both carriers offered by your company (e.g., if the company has 2 employees enrolled in health insurance, those 2 employees can be enrolled across both Kaiser and Aetna).

Kaiser Permanente & UHC

At this time, for a company to provide access to medical insurance for their employees through Justworks, they must:

Have a minimum of 2 eligible employees from different households enroll
Have a minimum of 40% of benefits-eligible employees enroll (regardless of waivers)
No more than 10% of the company’s enrolled employees can be on COBRA (e.g., if 19 enrollees, only 1 can be on COBRA because 2 or more on COBRA would be over 10%)
If a controlled group is starting medical benefits at the same time (i.e., all entities share the same medical insurance start date), they may meet eligibility requirements collectively, as long as they have been underwritten together. This means they must offer the same medical plans and have identical medical insurance rates across all entities.
The company must have at least 1 W-2 employee to be considered eligible (this means that the entire company cannot be composed of only unpaid owner)s.

UnitedHealthcare

Your company must meet the following criteria:

Have a minimum of 2 eligible employees from different households enroll
Have a minimum of 40% of benefits-eligible employees enroll (regardless of waivers)
No more than 10% of the company’s enrolled employees can be on COBRA (e.g., if 19 enrollees, only 1 can be on COBRA because 2 or more on COBRA would be over 10%)
If a controlled group is starting medical benefits at the same time (i.e., all entities share the same medical insurance start date), they may meet eligibility requirements collectively, as long as they have been underwritten together. This means they must offer the same medical plans and have identical medical insurance rates across all entities.
The company must have at least 1 W-2 employee to be considered eligible (this means that the entire company cannot be composed of only unpaid owners.

Open Market Plans Carrier Eligibility Requirements

Please review the minimum requirements based on the state where your company headquarters (HQ) is situs.

Alaska (AK)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

Alabama (AL)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Arizona (AZ)

AZBlue (BCBS)

Your company must meet the following criteria:

Have a minimum of 1 eligible employee enrolled.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Arkansas (AR)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

California (CA)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 70% of benefits-eligible employees enroll, excluding those with valid waivers.

Blue Shield of CA

Your company must meet the following criteria:

Have a minimum of 65% of benefits-eligible employees enroll, excluding those with valid waivers.

CalChoice

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Kaiser Permanente

Your company must meet the following criteria:

Have a minimum of 1 California-based eligible employee enrolled.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Colorado (CO)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 70% of benefits-eligible employees enroll, excluding those with valid waivers.

Kaiser Permanente

Your company must meet the following criteria:

Have a minimum of 1 benefits-eligible employee enrolled.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll.

Connecticut (CT)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 70% of benefits-eligible employees enroll, excluding those with valid waivers.

Oxford (UHC)

Your company must meet the following criteria:

Have a minimum of 1 benefits-eligible employee enrolled.

Delaware (DE)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

Florida (FL)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Georgia (GA)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Kaiser Permanente

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Hawaii (HI)

Kaiser Permanente

Your company must meet the following criteria:

Have a minimum of 1 benefits-eligible employee enrolled.

Idaho (ID)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Illinois (IL)

BCBS IL

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Indiana (IN)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enrolled.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enrolled.

Iowa (IA)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Kansas (KS)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Kentucky (KY)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Louisiana (LA)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Maine (ME)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Maryland (MD)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 60% of benefits-eligible employees enroll, excluding those with valid waivers.

Massachusetts (MA)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Group Size Greater than 5 employees: Have a minimum of 75% of benefits-eligible employees enrolled, excluding those with valid waivers.
Group Size 1-5 employees: Have a minimum of 100% of benefits-eligible employees enrolled, excluding those with valid waivers.

Michigan (MI)

UnitedHealthcare (UHC)

No minimum requirement.

Minnesota (MN)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

Mississippi (MS)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Missouri (MO)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Montana (MT)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

Nebraska (NE)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 70% of benefits-eligible employees enroll, excluding those with valid waivers.

Nevada (NV)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

New Hampshire (NH)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

New Jersey (NJ)

BCBS (Horizon)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

Oxford (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

New Mexico (NM)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

New York (NY)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 60% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (Oxford & UHC)

Your company must meet the following criteria:

Have a minimum of 60% of benefits-eligible employees enroll, excluding those with valid waivers.

North Carolina (NC)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

North Dakota (ND)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Ohio (OH)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enrolled.

Oklahoma (OK)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Oregon (OR)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

Pennsylvania (PA)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

At least 75% of benefits-eligible employees must enroll (excluding those with valid waivers), and there should be a minimum of 50% enrollment among all eligible employees.

Rhode Island (RI)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

South Carolina (SC)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

South Dakota (SD)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enrolled.

Tennessee (TN)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 25% of benefits-eligible employees enrolled.

Texas (TX)

BCBS TX

Your company must meet the following criteria:

Have a minimum of 70% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Utah (UT)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enrolled.

Virginia (VA)

Anthem (BCBS)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

Kaiser Permanente

Your company must meet the following criteria:

Have a minimum of 1 benefits-eligible employee enrolled.

Washington (WA)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 75% of benefits-eligible employees enroll, excluding those with valid waivers.

West Virginia (WV)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

If employer contribution is 100%: 100% of eligible employees must enroll, excluding those with valid waivers.
If employer contribution is less than 100%: No participation requirement applies.

Wisconsin (WI)

Anthem (BCBS)

Your company must meet the following criteria:

For 2-4 benefits-eligible employees: a minimum of 2 must enroll
For 5-6 benefits-eligible employees: a minimum of 3 must enroll
For 7 benefits-eligible employees: a minimum of 4 must enroll
For 8-9 benefits-eligible employees: a minimum of 5 must enroll
For 10 benefits-eligible employees: a minimum of 6 must enroll
For more than 11 benefits-eligible employees: 70% of employees must enroll after valid waivers

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Wyoming (WY)

UnitedHealthcare (UHC)

Your company must meet the following criteria:

Have a minimum of 50% of benefits-eligible employees enroll, excluding those with valid waivers.

Disclaimer

This material has been prepared for informational purposes only, and is not intended to provide, and should not be relied on for, legal or tax advice. If you have any legal or tax questions regarding this content or related issues, then you should consult with your professional legal or tax advisor.