Eligible Employees for Group Plans

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In order to participate in a group health insurance, an employee must meet a few basic criteria (though this is likely to change in the coming years).  Part time employees including seasonal and temporary employees may be excluded either by the employer, by the state’s own laws, or by the health insurance company.

All states have different eligibility laws as some, like Florida have the cutoff at 25 hours per week. Additional criteria can include waiting periods, employee status, and even prior coverage.

What can be more difficult to swallow are some of the preexisting periods for maternity, as this thorny issue has caused many a family to either change or maintain their employee status just to qualify for benefits.  Check your state’s laws or call East Coast Health Insurance at 888 803 5917 for more information about qualifying for group health coverage in your state.


We have devoted an entire section to HIPAA (Health Insurance Portability and Accountability Act) which acts to protect unemployed and terminated former employees from losing coverage.

Many states like Florida allow for one man groups, usually this period is a one month qualification period, and the states that typically allow for one man groups don’t have risk pools for the uninsurable.

Waiting Periods

The waiting period that most employees must wait prior to being accepted onto a group health insurance plan is typically 90 days.  Most states allow a maximum of 90 days or 120 days before employers must include their new employees in the business health plan.

Once the waiting period is met, the employee is then allowed to either accept or decline coverage.  Beware, however, employers, as I have seen one employee turning down coverage (this only applies to new groups and two man groups) turn an entire group into becoming ineligible – especially for the smaller groups.

If the employee declines coverage into the group most companies make them wait until the next enrollment period before they can consider joining the group plan again.  So be very careful when declining coverage as it could mean the difference between thousands of dollars in medical expenses.

Of course, if there is a special circumstance, employers must make an exception if their status changes, either through a death, birth, or loss of coverage etc.  These windows for special enrollment usually only last for 30 days, so if you are someone who declined coverage only to find themselves needing it, you should immediately contact your human resource department and ask them about this special enrollment period.


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