Participation/Documentation Requirements
Please note that carriers require approximately75% participation (enrollment) of eligible employees. Eligible employees are employees who work more than 25 hours per week and do not have other creditable coverage (ex., coverage through a spouse, Cobra, or Medicaid). Those employees are eligible to waive coverage under a qualified waiver. Individuals with personal health insurance policies are not eligible to waive group coverage and if they do so, it is considered a non-qualified waiver. 1099 employees may be eligible to enroll with documentation. Carriers require that employers contribute a minimum of 50% of the employee only premium.
Documentation required for group coverage is usually a UCT-6 and IRS 941. There are some exceptions. All paperwork and documentation must be submitted the first of the month prior to the requested effective date.
