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Each of our medical carriers have minimum eligibility requirements that your company must satisfy 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
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Have a minimum of 2 eligible employees from different households enroll
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Have a minimum of 50% of benefits-eligible employees enroll (regardless of waivers)
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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%)
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Controlled Groups can meet these requirements across entities as long as they are underwritten together, meaning all entities within the controlled group are offering the same plans and have the same rates.
Please note that these minimum eligibility requirements do not apply to Aetna Vision or Dental insurance policies.
Kaiser Permanente
At this time, for a company to offer Kaiser Permanente plans alongside Aetna, they must have at least five benefits-eligible employees. Additionally, your company must meet the following criteria:
- For companies that have 5 benefits-eligible employees, all 5 employees must enroll in a medical plan.
- For companies that have 6-10 benefits-eligible employees, at least 5 employees must enroll.
- For companies that have 11 or more benefits-eligible employees, at least 50% of the group must enroll.
- No more than 10% of the company’s enrolled employees can be on your COBRA policies (e.g., if the company has 19 enrollees, only 1 can have coverage under your company’s COBRA because 2 or more on your COBRA would be over 10%).
- Controlled Groups can meet these requirements across entities as long as they are underwritten together, meaning all entities within the controlled group are offering the same plans and have the same rates.
- 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.
As a reminder, Kaiser Permanente must be offered alongside Aetna. This means the criteria described above apply across both carriers offered by your company (e.g., if the company has 5 employees enrolled in health insurance, those 5 employees can be enrolled across both Kaiser and Aetna).
UnitedHealthcare
Your company must meet the following criteria:
- Have a minimum of 2 eligible employees from different households enroll
- Have a minimum of 50% 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%)
- Controlled Groups can meet these requirements across entities as long as they are underwritten together, meaning all entities within the controlled group are offering the same plans and have the same rates.
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.