Eligibility flexibility for January 1st coverage
Small businesses that start their health plans on January 1 have more flexible eligibility rules that make it easier to offer coverage. Specifically, they do not have to meet the following standard eligibility requirements:
- Fifty percent minimum employer contribution toward employee premiums, and
- Minimum participation by two-thirds of eligible employees.
For example, an employer has 10 full-time employees, but only 5 want health coverage and don’t have other qualifying coverage. Or, an employer has 5 full-time employees, but can only contribute 25 percent of the cost of coverage for each employee.
Usually these employers would be ineligible because they don’t meet the requirement that the employer must contribute at least 50 percent toward employees’ monthly premiums and that two-thirds of eligible employees either enroll in coverage or notify DC Health Link that they have other qualifying coverage (a waiver). With a January 1 start date, these requirements are not applicable.
Employers starting their plans on January 1 still need to meet all other eligibility requirements.