What happens if half of an employer’s employees would be better off applying for individual coverage rather than group coverage, because they could be eligible for premium assistance and cost-sharing reductions?

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Home »Frequently Asked Questions »What happens if half of an employer’s employees would be better off applying for individual coverage rather than group coverage, because they could be eligible for premium assistance and cost-sharing reductions?Covered CA

What happens if half of an employer’s employees would be better off applying for individual coverage rather than group coverage, because they could be eligible for premium assistance and cost-sharing reductions?

Waiving coverage to enroll in the Individual Marketplace is not a valid waiver. Hence, 50% participation due to employees enrolling in the Individual Marketplace will make the employer ineligible for Covered California for Small Business since the participation requirement for Covered California for Small Business is 70%. However, the group can enroll during the special open enrollment period. In the small group market, a health insurance issuer may limit the availability of coverage to an annual enrollment period from November 15 till December 15 of each year if the employer is unable to meet employer contribution or group participation requirements.

There may be a more recent answer to this question. Contact Claremont for an update.