California health insurance  -  California Group Insurance  -  Group Eligibility for Insurance

What's Required To Qualify For Small Group Health Insurance in California?



There are requirements needed to qualify for guaranteed issue coverage otherwise the market would have issues.




The three main ones are following. These are three most common to cause issues if there are any for new group.


You can always run your California Employer health quote here:


quote California employer health plan rates

 We need at least one person officially connected to the company for half of the prior calendar quarter PLUS one non-spouse on payroll


This requirement usually poses a roadblock (or hurdle) for smaller companies and especially family owned companies.


Most of these companies are Sole proprietors which means that in the eyes of the law (and the health insurance carrier), there's really only one person tied to the company officially.


Most family businesses do not put the other spouse on payroll due to cost. We either need payroll or some type of ownership (partner, officer, etc).


"half the prior calendar quarter".


Start-up companies usually run into this issue.


We need the two people mentioned above for at least have of the prior calendar quarter.


For example, if you want a April 1st effective date, the two people must be officially tied to the company (payroll ideally with DE6, Statement of Information listing officer with stamp by State, etc) by Feb 15th.


Otherwise, it pushes us out to July 1st (the next calendar quarter).


Each company's structure and timing is unique so it's a good idea to run your situation by us to really understand the timetable and requirements.


Out of State or Foreign Corporations.


We often have companies which are incorporated in other States or who are setting up an office in California for which they need California group health insurance.


In this case, we generally need a Certificate of Qualification in California which allows the company to operate here.


Keep in mind that the carriers will look at the official stamped filing date and not the filing date to establish the "half of prior calendar quarter" requirement mentioned above




For LLCs, the carriers typically look at the stamped date from the State for documents listing the Managers although we might find subtleties in requirements from the different carriers.

We need at least 75% of the eligible employees/owners to enroll on the plan



This is the next big requirement that trips up some companies. If too many eligible employees decline coverage (for example, due to cost), we may not be eligible.




Let's define what an eligible employee is (and is not).

1099 Contract workers are not eligible and therefore do not figure into our 75% calculation.


1099 workers are not eligible to join a California group health insurance (other than their own if eligible).


Part Time employees.


This depends on what the carrier opts for. A company can choose to cover part time employees (below 30 hours weekly). If part timers are included, they will be calculated into the 75% requirement.


Other employees not included.


If a person is on another group health insurance plan (say through spouse) or on Medicare, we do not need to consider them in our calculation although they are eligible to join the group plan.


So where do we see issues?.


With a small company, let's say we have 3 eligible employees and one does want to join.


In this case, we have 66% participation and may not be able to form a group plan.

Variations to the Participation Rule


The carriers are testing different participation rules (50%, 25%, etc) so check with us on your particular situation. 


Also, as a result of the ACA law, there's a special year-end Open Enrollment window during which some of the Eligibility requirements may be waived. 


Check with us if you feel you are unable to meet the main requirements.


One other note...the carriers have different requirements for the number of employees being in California (versus other States) that run from 25% to 51%.

The company must pay at least 50% of the employee premium.  


The company must pay 50% of the employee (not dependents) premium. A company can do this as a fixed dollar amount or percentage of a given plan (or any plan of choice) as long as the company does not discriminate.




Take advantage of our experience in the group market by requesting a full proposal for your company.


It is advisable to speak with your California health insurance agent or broker about your particular company's situation to see if you qualify.


Related Pages:
Group Health for New Companies
How to Choose Group Health Plans in California

Call 800-320-6269 or email with any questions

  Follow on social media

Covered Ca tax credit
Call 800-320-6269
Our Services are FREE to You!

Call to Enroll over the Phone in 15 Minutes

enroll in Covered Ca Exchange coverage

Call 800-320-6269

Anthem Blue Cross California
Blue Shield of California under Covered California
Kaiser of California
Molina health through Covered California
Sharp health plan in Covered California
and more
Thousands of Californians
Hundreds of California Companies
Thousands of Californians
Hundreds of California Companies

from SC

"My sincere thanks for making a miracle happen- 2014 health insurance !! Many thanks for your expertise and advice yesterday !!"

from SD

"Thanks again for your help - I had absolutely no idea how to get this done when I got up this morning. You've made it remarkably easier than I expected. I hope you're not stuck at the office all night..."

from KV

"Anyway, I hope you got some time off this past week! Thank you again for your help and efforts on my behalf! I was very lucky to find you."

from EK

"I thank you very much for the time that you have invested in handling everything

from SR

"I truly appreciate the quick response and will think of you in the future if I need to make any changes to my insurance plans."

from VH

"You are awesome... takes a huge worry off my back, thank you for your kind. thanks for your time and kindness. !!"

from SA

"Wow, I can't thank you guys enough for your help...I couldn't imagine trying to tackle this on my own!"

from LM

"You are my new best friend. A HUGE thank you again.

Find out what customers are saying about our services

20 years of experience in the California health insurance market has taught us one thing...Competent and experienced guidance is Invaluable

We can quickly (very important) size up your health insurance needs and clearly explain the options available to you. Our focus is finding the most coverage at the best cost to you.

We are licensed Covered Ca agents with in-depth knowledge of their plans, process, and tax credits.

Call will be Pleasantly Surprised.  800-320-6269

Request a 10 Minute Health Plan Check-up

We'll quickly see if you have the best priced plan available and if you qualify for a tax credit


Our Services are FREE to You is a Goodacre Insurance Services Website

This website is owned and operated by Goodacre Insurance Services, which is solely responsible for its content. This site is not maintained by or associated with Covered California, and Covered California bears no responsibility for its content. The email address and phone numbers that appear throughout the site belong to Goodacre Insurance Services, and cannot be used to contact Covered California.