Effective January 1, 2014 for new business and as existing groups renew thereafter, Husband and Wife only and Partner only businesses are no longer eligible for Small Group coverage.
There are differences on how each state* will handle immediate family members who are also employees.
- Sole proprietors, owners and their immediate family members forming a business are not considered employees and may only buy insurance through the Individual Marketplace.
- Sole proprietors reporting on Schedule C cannot form a group health plan without having at least one non-spouse common-law employee.**
In the FFM State Private Group Market, Sole Proprietor and Partner only businesses are still not eligible to form a group but if they include additional immediate family members who are common-law employees, they are eligible for Small Group coverage.
** Employee (Common-Law Employee) – Under common-law rules, anyone who performs services for you is your employee if you can control what will be done and how it will be done. This is so even when you give the employee freedom of action. What matters is that you have the right to control the details of how the services are performed.
Husband and Wife Groups
Husband and Wife groups with immediate family members and no other (non-related) employee on payroll cannot form a group.
- All Husband and Wife groups, in which the only two employees of the company are the two spouses, regardless of tax filing or corporate structure, will not be eligible for Small Group Health Insurance in both the FFM, State or Private Marketplaces.
In the FFM State Private Group Market, Husband and Wife only businesses are still not eligible to form a group but if they include additional family members who are common-law employees, they are eligible for Small Group coverage.
Existing Husband and Wife only and Partner only groups will be non-renewed in 2014.
New York: Since New York created its own exchange, Husband and Wife only and Partner only businesses with or without family members will not be permitted both in the SHOP exchange and in the Private Small Group market.
PPACA is using verbiage directly from the IRS. Legislatively, this has also been true since HIPAA in 1996.
Groups Certified for January/February 2014
Carriers are reviewing how they will handle such groups that have certified for January and February of 2014. We will provide additional information when it becomes available.
Individual Products Market
If you are are losing their Small Group Health coverage due to compliance issues, we can offer you Individual and Family Health Insurance. For more information on Individual Products, click HERE or contact Jennifer Bremme Account Manager, Individual Products, via email@example.com or 800.924.6718 ext. 19.
If you have any questions regarding Small Group coverage, please contact your dedicated Total Benefit Solutions Account Manager.