Group Health Insurance Requirements for Small Employers

If you're a small business owner thinking about offering group health insurance, understanding the basic requirements helps you set up a plan that qualifies and protects both you and your employees.

Federal Requirements

Businesses with fewer than 50 full-time equivalent employees are not required by the ACA to offer health insurance. However, if you choose to offer it, the plan must meet minimum value and affordability standards to avoid penalties related to larger employer provisions.

State Requirements

States may have additional requirements around participation rates and employer contribution minimums. In Georgia, Florida, Maryland, Virginia, and the other states BenZen serves, participation requirements typically range from 50–75% of eligible employees.

Participation and Contribution Rules

• Minimum participation: Most carriers require a minimum percentage of eligible employees to enroll
• Employer contribution: Most carriers require the employer to contribute at least 50% of the employee-only premium
• Eligible employees: Typically defined as full-time employees working 30+ hours per week

Getting Started

Setting up a group plan involves choosing a carrier, selecting plan options, and managing enrollment. An independent broker simplifies this significantly at no cost to the employer. BenZen can walk you through it.