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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).
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Companies with <5 EEs must have 2 employees from different households enrolled
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Companies with >5 EEs MUST have a minimum of 50% of employees enrolled
- You can have no more than 10% of the company’s enrolled employees on COBRA (e.g., if the company has 19 employees, only 1 can be on COBRA because 2 or more on COBRA would be over 10%)
- 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 6-10 benefits-eligible employees at least 5 EEs 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 COBRA (e.g., if 19 enrollees, only 1 can be on COBRA because 2 or more 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 <5 employees, you must have a min of 2 benefits-eligible employees enroll in a medical plan.
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If you have >5 employees, then 50% of the eligible employees must enroll
- 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%)
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.