What makes a small business eligible?

When considering if an employer meets the criteria for a small group, the employer must:

  • Be a full-time business
  • Be engaged in producing income
  • Have a Tax ID number and Quarterly Contribution Return and Report of Wages (Continuation) (DE 9C).
    • Partnerships or Limited Liability Companies (LLC) must have an IRS Schedule K listing all partners (minimum two required)
  • Employ 1 to 50 permanent full-time eligible employees on at least 50 percent of its working days during the preceding calendar quarter or calendar year
  • Have at least 51% of its eligible employees employed in California.
  • Offer health plan coverage to 100 percent of its eligible employees.

Other guidelines:

  • If the employer is located outside WHA service area, only employees residing in our service area will be eligible for coverage.
  • If a group is termed for non-payment of premium, they cannot reapply for WHA coverage for six months.
  • The employer cannot be formed primarily for the purpose of obtaining health coverage.

The following are groups that are not considered small groups:

  • Associations
  • Retirees
  • Multiple employer trust
  • Union trust plans
  • Taft-Hartley groups
  • A group whose only eligible employees are married (i.e. both owners/partners or one owner, one employee)

What if my business is a start-up?

If your new business does not yet have a DE 9C, it must be in business for at least four weeks:

  • In this event, copies of payroll records for this length of time preceding the group’s effective date is required. The payroll documentation will be subject to WHA underwriting approval.
  • A copy of the DE 9C for the first quarter will need to be submitted, once available. 

If your partnerships or LLCs does not yet have a Schedule K, you must include a copy of:

  • The Partnership Agreement/Articles of Incorporation
  • Filed Statement of Information (with state seal affixed) listing the names of the partners/officers.

All documentation will be subject to WHA underwriting approval.

Underwriting guidelines

Contribution

The employer must contribute a minimum of 50 percent of the employee’s premium for the lowest cost plan offered by WHA. Any other contribution arrangements are subject to WHA underwriting approval.

Participation

A minimum of two employees must enroll in WHA, except when there are valid waivers by all other eligible employees or only one eligible employee is listed on the DE 9C.

When WHA is offered as a dual option, at least two must enroll.

Waiting Period

WHA administers the health plan on a whole-month basis only. Therefore, the employer has the option of choosing one of two waiting periods:

  • First day of the month following the date of hire; OR
  • First day of the month following 30 days.
Other Plan Rules

Employers may offer a choice of up to three WHA plan options to their employees. A minimum of three enrolled employees is required. Two HSA-compatible high-deductible (HSA) plans cannot be offered side by side within one eligibility class of a group.

  • Benefit plan deductibles are based on a calendar year, and therefore, all deductibles reset on January 1st.
  • If a group’s effective date or renewal date is during the calendar year, WHA will honor deductible carryovers from a prior carrier under the following circumstances:
  • Group HSA plan to group HSA plan only.
  • Only amounts paid for services that would have been covered under WHA plan and subject to the deductible are eligible for the carryover.
  • Prior carrier deductible documentation must be submitted within 30 days of the member’s effective date with WHA in order to receive the carryover credit.
  • A Health Savings Account (HSA) with HealthEquity is included with all Gateway and Capital HSA plans (unless the employer declines the benefit). Employees must complete the HSA Authorization Form at the time of enrollment in order for WHA to establish their account.

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