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Each of our medical carriers have minimum eligibility requirements that your company must satisfy in order to qualify for medical plans through Justworks and to renew those plans each year during annual health insurance renewals. If your company falls below the minimum eligibility requirements in the middle of the calendar year, Justworks will not cancel your policies. However, if you do not satisfy the minimum eligibility requirements by the time health insurance renewals arrive each fall, you will not be able to renew your plans for the upcoming plan year.
Aetna
Your company must meet the following criteria:
- You must have a minimum of 2 benefits-eligible employees enroll in a medical plan
- Each employee enrolled must reside in a separate household(for example, two spouses residing in the same household cannot sign up as two separate eligible employees because they are part of one household).
- You can have no more than 15% of the company’s enrolled employees on COBRA (e.g., if the company has 19 employees, only 2 can be on COBRA because 3 or more on COBRA would be over 15%)
- The company must have at least 1 W2 employee to be considered eligible (this means that the entire company cannot be comprised of just unpaid owners)
Please note that these minimum eligibility requirements do not apply to Aetna Vision or Dental insurance policies.
Kaiser Permanente
Your company must meet the following criteria:
- You must have a minimum of 5 benefits-eligible employees enroll in health insurance.
- Each employee enrolled must reside in a separate household (for example, two spouses residing in the same household cannot sign up as two separate eligible employees because they are part of one household).
- For companies that have 5 benefits eligible employees all 5 EEs must enroll in a medical plan.
- For companies that have < 11 benefits eligible employees at least 5 EEs must enroll
- For companies that have > 11 benefits eligible employees at least 50% of the group must enroll.
- If any of your benefits-eligible employees have valid waivers, for example, if they have health insurance outside of Justworks through a spouse, then at least 75% of your remaining benefits-eligible employees must enroll in a medical plan (for example, if you have 10 benefits-eligible employees and two of them have valid waivers, then at least 6 of your remaining benefits-eligible employees must enroll in a medical plan).
- No more than 10% of your enrolled employees can be on COBRA (for example, if you have 19 enrollees in total, only one enrollee can be on COBRA because two or more enrollees on COBRA would be over 10%).
As a reminder, Kaiser Permanente must be offered alongside Aetna.
UnitedHealthcare
Your company must meet the following criteria:
- You must have a minimum of 2 benefits-eligible employees enroll in a medical plan.
- Each employee enrolled must reside in a separate household (for example, two spouses residing in the same household cannot sign up as two separate eligible employees because they are part of one household).
- If you have less than 6 W-2 employees, a minimum of 2 employees must enroll in a medical plan.
- If you have 6 or more W-2 employees, then 50% of the benefits-eligible employees must enroll in a medical plan.
- If any of your benefits-eligible employees have valid waivers, for example, if they have health insurance outside of Justworks through a spouse, then at least 75% of your remaining benefits-eligible employees must enroll in a medical plan (for example, if you have 10 benefits-eligible employees and two of them have valid waivers, then at least 6 of your remaining benefits-eligible employees must enroll in a medical plan).
- No more than 15% of your enrolled employees can be on COBRA (for example, if you have 19 enrollees in total, only 2 enrollee can be on COBRA because 3 or more enrollees on COBRA would be over 10%)
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.