group process.
The following pages contain instructions on how to process a small group quote, complete an online Employer Group application, begin/close employee Open Enrollment and submit a completed group for enrollment into Meritus utilizing the Meritus Broker Sales Portal at meritusaz.com for Small Group - 2-50 Employees.
Small Group Underwriting Requirements
• Minimum of 2 eligible enrolling employees • Minimum of 70% participation excluding
valid waivers
- Valid waivers include Medicare, TriCare, AHCCCS, Indian Health Services and Spousal Coverage
- Individual coverage is not a valid waiver • Out-of-Area Employees – 75% or more of eligible
employees must reside in the Meritus Arizona service area (Maricopa, Pima or Santa Cruz, or Mohave County). A PPO plan would be the only option for Out-of-Area employees (less than 25% of the eligible employees).
• Employer may choose to offer up to three (3) Plans
• Employer Contribution – Minimum 50% of the employee-only premium cost across all plans offered
• First of the Month effective dates only and new hire waiting periods cannot exceed 90 days. Waiting period options are:
- FOMF Date of Hire - FOMF 30 Days - FOMF 60 Days
• Group Application must be submitted by the
23rd of the month prior to the effective date. Enrollment must be completed by the 30th of the month.
Small Group Eligibility
• Full-Time Employee Definition – Employer determines definition of full-time status; no full-time status defined as less than 20 hours per week.
• 1099 Employees
- Sole contract with Group – must have Employer/Employee relationship
- Work hour requirement equal to that of eligible W-2 employees
- Employer must provide working environment • Domestic Partners allowed
• Current Quarterly Wage & Tax Report (Form UC018) Required – For new employees not listed on the report, indicate names and dates of hire on the W&T report or separate sheet.
• Newly Formed Group – Will accept a newly formed group provided two weeks of payroll is submitted.
• Owners & Partners – Applies when owners are not on the quarterly wage & tax report. Must submit legal ownership documents that show affiliation with the group and Articles of Incorporation. If LLC, all owners must be listed. • Workers Compensation – All employees, except
those not required by law, must be covered by workers’ compensation.
Meritus Rules for Small Business Health Options Program (SHOP) plans on the Marketplace
In 2015, small businesses that offer coverage through the Federally-Facilitated SHOP (FF-SHOP) will be able to choose a Qualified Health Plan (QHP) to offer their employees.
Eligibility Requirements for SHOP
Employer’s business must:
• Be located in a SHOP’s service area. • Have at least one eligible employee
on payroll (generally excludes owners, including sole proprietors, and owners’ spouses and dependents on payroll). • Have no more than 50 full-time equivalent
(FTE) employees on payroll.1
• Offer coverage to all full-time employees (full-time status is defined as working more than 30 hours per week).
Eligibility Requirements for the Small Business Tax Credit
The small business must:
• Have an average of fewer than 25 FTE employees (based on a 40-hour work week and excluding owners, owner’s family members and seasonal employees). • Have average annual employee wages
below $50,000.
• Pay a uniform percentage (at least 50%) of the cost of each employee’s health insurance.
• Offer coverage to all full-time employees (full-time status is defined as working more than 30 hours per week).
1 Part-time workers must be counted as fractions of
an FTE when determining employer size, even if part-time workers are not offered coverage, but does not include seasonal employees who work fewer than 120 days per year.
As an Agent or Broker, you may receive additional questions from employers regarding their SHOP eligibility. Some additional requirements to consider include:
• Employers that are part of the same controlled group must count all employees at the combined entities when answering eligibility questions.
• Employers must have at least one common- law employee. Sole proprietors reporting on Schedule C cannot form a group health plan without having a common-law employee.
• A group cannot consist solely of S corporation shareholders or spouses (S corporations are corporations that pass corporate income, losses, deductions and credit through to their shareholders for federal tax purposes).
• Under the common-law standard, an employer-employee relationship exists when the business has the right to direct and control the worker.
Enrollment and Annual Renewal in SHOP
For the employer to be able to offer coverage to employees, at least 70% of the total number of employees must participate and sign up for coverage (excluding employees who have other creditable coverage, such as another group plan or public health insurance). If an employer offers affordable coverage to an employee, the employee is ineligible for premium tax credits in the individual Marketplace. Employer- sponsored insurance is considered unaffordable if an employee’s share of the self-only coverage is more than 9.5% of the worker’s household income.
Under the Affordable Care Act, employers participating in SHOP are not required to offer dependent coverage. Dependents covered through a SHOP plan are ineligible for premium tax credits and cost-sharing reductions in the individual Marketplace as well.
An employer must submit the application for SHOP with the first month’s premium by the 15th of the month for coverage to begin the first of the following month.