How many employees are required for group health insurance?

Companies of all sizes pride themselves on offering health insurance with their employees’ jobs. It is an enormous perk, one that can’t be underestimated, and something that those searching for full-time jobs have come to expect. But with small businesses and those that employ remote workers on the rise, it can be common to question how many employees are needed to qualify for a group health insurance plan.

To be eligible for group health insurance (which is often cheaper than individual plans), a company must have between one and 50 employees. This allows companies to apply for small group coverage, and those with more than 50 employees can only apply for large group coverage. But, there are other requirements.

Requirements Beyond the Number of Employees for Group Insurance

In addition to the right number of employees, you need to satisfy the following requirements:

Certified Office Space.

Another key necessity to qualifying for group health insurance is that you must have a certified office or workspace in the state in which you are applying for group coverage.

One of the Employees Cannot Be the Owner.

Additionally, the only covered member cannot be the owner of the company — they cannot also be the spouse of the owner or member of the owner’s family. If your company is one that you and a spouse run as the sole employees, you would need to apply for coverage through a MEWA plan until other workers unrelated to the owners join the staff. But once you have enough employees to qualify for group coverage, the market would open up.

Full Time Employees.

Employees must work on a full-time basis. Insurance cannot be offered to part-time workers, but it is not necessary to as they won’t count toward your minimum to qualify for group coverage. Your full-time employees are considered those who work at least 25 hours per week. Note that seasonal employees do not count, even if they are indeed working for 25 hours during their term of employment.

Enrollment Percentage.

Companies accepting group coverage are also required to enroll at least 75 percent of eligible employees. Those with differing insurance plans do not count toward this minimum rule, and know that enrollment happens annually usually in the month prior to the group’s renewal.

Wondering how you and your company can qualify for group health insurance, and curious about which plan you should go with? Let the experienced insurance broker of Dawson Benefits help you navigate this intricate course — call today for a free consultation.

Can I keep my doctor if I switch health insurance plans?

Switching health plans can bring about a lot of anxiety — it’s a major transition for some, and it is often a highly personal, medical, and financial decision. As such many dally in changing their plans, even if it is more beneficial to, as they say, rip the band-aid off.

But one principal concern in switching health insurance plans is defining whether or not you get to keep your doctors after you make the change. Patients establish trusted, healthy, and sometimes even lifelong relationships with their doctors, and leaving your medical professional can be difficult; they are the keepers of your entire clinical history and know how to communicate with and treat you. But changing insurance plans does not also necessarily mean losing your medical contact.

Obtain a List from Your Doctor of Participating Insurance Plans

When choosing a new insurance plan, there are lots of steps to take to see if this means going to a new doctor. To start, request from your doctors or their staff a list of networks they are contracted with. (This may also be on their website.) From there, you know exactly who you can switch to while still staying in-network. The work that follows, of course, entails finding out which plan is a good fit, financial and otherwise, but websites like healthcare.gov or using state or private exchanges can be helpful.

What to Do if Your Doctor Is Not in the Plan You Are Considering

But it’s also very possible that the new health insurance plan that you’ve been considering is not one your beloved doctor accepts. Fear not: this does not mean the end of the road. Talk to your doctor; perhaps some kind of an agreement can be arranged, or perhaps he or she has been getting requests from other patients about your chosen network and so the office may consider adding it to their plans.

However if it turns out that plan cannot be accepted, you may have to make a firmer decision. Without your insurance to cover key expenses, you’ll have to decide whether staying with your doctor and paying out-of-pocket is worth it, or perhaps your doctor can still be of use: mention the network you plan on switching to, ask your doctor if they know of any neighboring facilities that accept that plan, and see if your doctor recommends any other professionals who could be a good fit for your needs. They’ll know you best and can find someone for you to have a fruitful relationship with.

If you’re considering switching plans or are unsure about what that means for your medical future, speak with our insurance broker — we’ll happily guide you through and discuss plans tailored to your needs!