A "small employer" group means a business or organization, which employed on average, one and up to 50 benefit employees, including owners and self-employed persons, on business days during the previous calendar year.In the case of an employer which was not in existence throughout the preceding calendar year, the determination of whether such employer is a small or large employer shall be based on the average number of employees that it is reasonably expected such employer will employ on business days in the current calendar year. A small employer is subject to this chapter whether or not it becomes part of an association, multi-employer plan, trust, or any other entity that meets this definition.
ELIGIBLE EMPLOYEES
"Eligible employee" means an employee who meets the requirements for eligibility set forth by the employer, the health coverage plan and state law. HPHC-NE defines an eligible employee as one who is eligible to receive company sponsored health benefits and who is a permanent employee who works on a full time basis with a normal workweek of 30 or more hours.
An eligible employee can also be a part-time employee who works a minimum of at least 15 hours a workweek, and who is hired for a period of at least 5 months. In NH, no insurer need accept or issue coverage to any employee deemed eligible by the employer who works less than 15 hours per week pursuant to RSA 415:18 I.(q).
Eligible employees include employees residing outside of HPHC-NE's enrollment area. Pursuant to New Hampshire law, COBRA participants shall be included as eligible employees in the determination of group size for rating purposes.
An employer/employee relationship or a business-like bond must exist.
NEW EMPLOYEES
New Hires are not eligible for HPHC-NE coverage until the employer’s probationary period has been met. HPHC-NE will only allow the employer to waive the probationary period at initial open enrollment for the ease of administration.
WAIVER OF COVERAGE
For the purpose of calculating whether or not a small employer group’s enrollment meets a carrier’s minimum participation requirements:
Any full-time or part-time employees who are covered as a dependent on another person’s health coverage shall be excluded from the count.
The total number of full-time employees and part-time employees who are otherwise eligible for health coverage shall be counted (with exceptions outlined below).
Waivers due to Spouse, Dependent, Medicare and Veterans coverage are acceptable waivers and are excluded from the participation calculation.
Waivers due to coverage through a second employer are considered acceptable waivers and are excluded from the participation calculation.
PARTICIPATION REQUIREMENTS
75% - sole source
37.5% - non sole source
PLAN SELECTION
For side-by-side offerings, the difference in relative pricing between the side-by-side offerings cannot be greater than 3