Small Employer Eligibility

If your company meets the definition of a "small employer" and satisfies the participation and contribution requirements described below, then you are guaranteed access to small group health coverage. 

Your company is eligible if:

Your company employed an average of at least two but not more than fifty eligible employees on business days during the proceeding calendar year; 

or:

Your company employed at least two employees on the first day of the plan year; and a majority of its employees work at a location in New Jersey. 

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If you have affiliated companies, they are treated as one company. Companies are considered affiliates if they are treated as a single employer under the Internal Revenue Code. All eligible employees of all affiliated companies, including employees of out-of-state affiliates, are considered in determining eligibility. If the number of eligible employees of affiliated companies when combined exceeds 50 eligible employees, the affiliated companies are not eligible for small group coverage.

Participation Requirement:
The state requires that 75 percent of your eligible employees participate in a health benefits plan you offer. Employees covered by a spouse's health benefits plan (except and individual plan) are counted as if they were participating under your plan, even if the employee declines coverage under your plan. If you offer employees multiple health benefits plans, the employees covered under other plans that you sponsor contribute toward the 75 percent participation requirements. 

Contribution Requirement:
Carriers will require you to pay a minimum of 10 percent of the total cost of a health benefits plan. You may pay a greater percentage, as much as 100 percent of the entire premium.


We also suggest you visit the NJ Small Employer Health Benefits Plans Buyer's Guide. This guide includes detailed information on Eligibility, Features of recent Reform, Types of Plans, Commonly asked Questions from employers, Description of the Standard Health Benefits Plans, Standard Indemnity Plans, Preferred Provider Organization without Copayment, Point of Service or Preferred Provider Organization, Standard HMO Point of Service Plan, and Standard HMO Plans. To have a printed copy of the guide, call toll free, 1-800-263-5912.

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