This article is about Justworks PEO. What product am I using?
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.
Large Group 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%)
- 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 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%)
- Controlled Groups can meet these requirements across entities as long as they are underwritten together, meaning all entities within the controlled group offer the same plans and 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 2 employees enrolled in health insurance, those 2 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 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%)
- 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.
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:
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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.