Group Health Insurance Eligibility

In 2014, the health insurance market changed forever with the implementation of the Affordable Care Act. Ever since then, the only consistent thing in the health insurance market has been change. One of the biggest health insurance changes happened in 2019. Through new legislation, health insurance companies started offering Association Health Plans to consumers in Nevada. Insurance Companies like Hometown Health, Prominence, Aetna,  Anthem and United all found ways to reduce rates for consumers through Association Health Plans. For the first time, sole proprietors and family run businesses also qualified for Association Health Plans through new group health insurance eligibility rules. Unfortunately, the rules changed for these types of business owners in the past few years. This article discusses the current eligibility rules as well as rules that are in legal limbo.

Current Eligibility Rules

As of September 28, 2020 the eligibility requirements for all small group plans in Nevada are the following:

  • There needs to be a minimum of two W-2 employees in the business (if there are only 2 employees enrolling in coverage, the 2 employees cannot be married).
  • The group health plan must be offered to all full time eligible employees. Nevada Revised Statutes define full time as a minimum of 30 hours per week (or 130 hours per month).
  • As an employer, you must contribute at least 50% of the premium for every employee enrolled on the plan.
  • Insurance carriers will require a minimum participation when you apply. Generally speaking, you need 50% – 75% of the uninsured full time employees in your business to sign up for coverage. The participation % is different with each carrier.
  • When you enroll, you will need to prove that you are a legitimate business with full time employees on payroll. Insurance carriers will request a Quarterly Wage Report confirming all your employees.

These requirements may seem daunting, especially since eligibility requirements keep changing. Fortunately, our licensed brokers are always staying up to date with legislative changes. We will help assess your eligibility and we will help with these requirements, at no extra cost to you.

Recent Legal Changes

Unfortunately, there have been more group health insurance eligibility changes in the market which affected these Association Health Plans. In New York, there is an ongoing federal court case affecting these rules nationwide. Sole proprietors and small businesses comprised of a single married couple no longer qualify for group health plans. The Nevada Division of Insurance is enforcing these newly revised rules until the court case is concluded. The Nevada Division of Insurance published a public bulletin discussing these health insurance changes. To read the public bulletin, please click here.

Your Options

There are plenty of options available in the market for employers looking to start a group health plan. Even if you do not meet the eligibility requirements to start a group health plan, we can help! We contract with every major medical insurance company in Nevada. We will also send you quotes based on your needs and preferences. Give us a call today to get a free quote for new coverage.