Group Insurance

Learn more about our Group Insurance

Depending on your status as an employer, group insurance may be beneficial to your business and employees. Group insurance allows for an employer to offer insurance for each of his employees within in a group, potentially saving the employee and the employer money. At NJ Life and Health Insurance Group, we provide the skills to walk you through the initial enrollment of a group from a business, or the evaluation of your business' current group insurance.

Overview of the Small Employer Health Benefits Program (SEH)

Under the NJ SEH Program, a small employer is defined as an employer with at least one but not more than 50 employees. While many businesses will qualify as small employers, others will not. Generally, small employers must satisfy both participation and contribution requirements to be eligible for a plan.

Small Employer Health Benefits Program (SEH) Participation and Contribution Requirements

At least 75% of the full-time employees of the business (working 25 or more hours per week) must be covered under the small employer health benefits plan being offered or covered under any one of the following which allows a waiver of the group plan coverage (but still counts as participation):

  • Medicaid or NJ Family Care

  • Medicaid or NJ Family Care

  • Another employer's or spousal employer's group health benefits plan

  • Tricare

Please note that coverage under an individual health benefits plan (through the Marketplace or direct to carrier) does not count towards satisfaction of the 75% required participation​

An employer is required to contribute at least 10% of the total cost of the health benefits plan offered to employees. An employer can pay up to 100%.

 

Exceptions to Participation and Contribution Requirements

The 75% participation requirement and the 10% contribution requirement does not apply to applications received during the Employer Open Enrollment Period (November 15th through December 15th) for an effective date of January 1st of any given year. 

Please note that although the 75% contribution requirement need not be met in these circumstances, small employers must still offer the plan to all eligible full-time employees.

The Small Business Health Options Program (SHOP)

The Small Business Health Options Program (SHOP) helps businesses provide comprehensive health coverage to employees with flexibility an incentives for employers contributing a higher amount to the total cost of coverage.

In order to qualify for SHOP, your business needs to meet the following 4 requirements:

  1. Have 1-50 full-time equivalent employees

  2. Offer coverage to all full-time employees (generally those working 30 or more hours per week)

  3. Enroll at least 70% of the employers being offered insurance (employees waiving coverage because they have coverage elsewhere are not counted as rejecting the offer)

  4. Have an office or employee work site within the state where you are applying for SHOP coverage

If your business chooses to participate in the Small Business Health Options Program (SHOP) you may qualify for the Small Business Healthcare Tax Credit. This credit can be worth up to 50% of your businesses premium contributions for the year. To qualify for this tax credit, you must also meet the following requirements:

  1. Have fewer than 25 full-time equivalent employees

  2. Have an average employee salary of $50,000 annually or less

  3. Must contribute at least 50% of your full-time employees' premium costs under the plan

Please note that similar to the requirements of the Small Employer Health Benefits Program (SEH), the participation requirement does not apply for applications received during the Employer Open Enrollment Period (November 15th through December 15th) for an effective date of January 1st of any given year. 

Please feel free to stop in our office or give us a call, and we will work with you to help answer any questions and evaluate your current insurance eligibility and options. We work with every major group health insurance carrier in NJ, allowing you to choose from all options available. 

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NJ Life and Health Insurance Group, LLC is not affiliated with or endorsed by the Social Security Administration or the Federal Medicare Program