What are the Minimum and Maximum Numbers of Employees Allowed by State Law to Participate in a Group Health Insurance Plan?

A group health insurance plan is a type of insurance plan which is purchased by the owner of a company. Those who are part of the plan are the individual employees of the said company. Basically, a single ‘master’ policy exists for a group of people. Some plans also have the additional option of providing coverage for the family members of those who are part of the plan. Because this type of plan has a lot of contributors (hence it is called a group plan), the policy is able to provide coverage for a broader range of services for a lower cost for each single member. The premium for a group health insurance plan is usually a flexible payroll deduction, and for some companies, the cost is covered fully by the employer as an added benefit for the workers.

Group health plans are required by law to accept anyone who applies. Most group health plans cover emergency and routine medical procedures—this includes regular appointments with doctors and immediate care for emergencies. Additionally, mental health problems and prescription drug expenses may be covered. Extended care in hospitals rehabilitation centers are usually also covered.

As for the minimum and maximum numbers of members allowed to participate in a group health insurance plan, most states provide a requirement that a company owner enroll a minimum number for coverage in order to be able to purchase and maintain a group health insurance plan. Generally, the number of members should be ten or more. However, some states will allow a group health insurance plan to be instated with less than ten members. Additionally, there is no legal limit to the maximum number of employees that may participate in a group health plan.

Another thing to take into mind is the type of group you have. There are generally two kinds—a small group and a large group. These are determined by number. While the minimum and maximum numbers of members allowed to participate are vague if you are looking at it from a general view, the numbers become more specific when you are aware of what type of group you have.

Small groups are classified for a company with a number of members between two and forty nine. While we previously mentioned that most states have a minimum requirement of ten in order to instate a group health plan, we also mentioned that some states can have a lesser number, which is why a small group can be as small as two people.

Meanwhile, a large group is the classification for a company with fifty or more employees. Usually, it is more difficult to choose a provider for a large company as additional factors might be considered. If you own a large group, you should find an insurance company which specializes in that specific type of group.

Policies have apparent differences which are based on what type of group you have. For example, if you own a small group, an insurance company may decline to provide coverage depending on the overall healthy history of the applying members. This is different from not allowing members to join the plan, because the plan has not been established in the first place.