If you have at least 50 full-time-equivalent employees but none receive an individual premium tax credit or cost-sharing reductions (both based on income), there’s no penalty—whether or not you offer health insurance.
Under federal law, small employers are guaranteed group coverage should they choose to purchase it, regardless of the employees’ health status.
These rules apply regardless of the medical condition of the employees.
In other words, any eligible employee can’t be denied coverage based on previous medical problems, known as preexisting conditions.
Below, we outline the basics behind group coverage.
Group medical coverage refers to a single policy issued to a group (typically a business with employees, although there are other kinds of groups that can get coverage) that covers all eligible employees and sometimes their dependents.Individual medical coverage, on the other hand, is a single policy issued to a single person or family.The rules are quite different for group coverage versus individual coverage, in large part because the insurer’s risk is calculated differently.From helping you create holistic health engagement programs to providing customer service 24/7/365 days a year, we help make sure you get the right combination of benefits and services, while reducing the stress and time it takes to administer a plan.Learn how we helped this 200-person self-funded group dramatically expand its employee wellness program to address the potential for high health risks and the costs and unscheduled absences that come with them.We’ll cover more essential details in Part Two: Getting Covered.Some employers who decide to offer coverage choose to pay the full premium, while others require employees to pay a portion.It's important that your benefits deliver more than just the basics.We start by taking the time to learn what matters most to you and your employees.Some states define the self-employed as “groups of one” and require insurers to guarantee issue them coverage in the small group market.The general rule is that if an employer offers group health coverage to any full-time employees, the employer must offer coverage to all full-time employees.