Guaranteed Issue and Renewal

Related Topics

Under the Affordable Care Act, small employers are guaranteed group coverage should they choose to purchase it, regardless of the employees’ health status. A “small employer” is defined as a business with 2 to 50 full-time employees. Owners are generally counted as employees, so sole proprietorships with one employee fall into this category, as do partnerships without any employees (by definition partnerships have two or more partners).

Small employers cannot be denied coverage as long as they:

  • Employ individuals who live, work or reside in the service area of a network plan
  • Satisfy minimum contribution or group participation requirements, to the extent allowed by state law or, in the case of a QHP offered in a small business health insurance exchange (SHOP), as permitted by § 156.285©
See the tool box for more details about “Laws Related to Health Insurance.”