Lets dive right into this.  Here are the requirements from Blue Cross

Group Size and Eligibility Requirements”

  • 1-5 employees:  100%
  • 6-50 employees: 75%

What does this mean?  Best way is to give you an example:

  • company has 5 employees
  • 2 employees have coverage with spouse
  • 2 want coverage through company
  • 1 does not want to sign up and will pay any penalties

If you try to submit this group to Blue Cross they will say that participation is 66.67% since 2 of the 3 eligible employees are enrolling.   Since the company is in the 1-5 range, they need 100% and are declined.

Pretty much all the other insurance companies have similar participation requirements.   Participation requirements needs to be eased or removed altogether since it is becoming very difficult for smaller companies to meet these requirements.

If you have any questions on your health insurance or would like some health insurance quotes send me an e-mail.   We represent all the major HMO’s.