Employee Eligibility

• You are prohibited from selectively excluding certain employees from participating in your LLC's health insurance plan. All eligible employees, as determined by your state, must be permitted to enroll in the plan if they meet established criteria. Typically, an eligible employee is defined as one working an average of at least 30 hours per week.
  
  

Participation Requirements

• Your LLC can get group health insurance if the group meets your state's minimum participation requirements. If too few employees choose not to enroll in the plan and those same employees do not have medical coverage elsewhere, your LLC's application will be denied. The average employee participation requirement ranges from 60 to 75 percent, depending on the state where your company is based. Employees declining the coverage, because they already have a group plan elsewhere, do not impact your participation requirements.
  
  

Contribution Requirements

• Your LLC can get group health insurance if the company is willing and able to contribute a percentage to each employee's premium costs. The minimum required contribution varies by state, with some as low as 10 percent and others as high as 50 percent. If your LLC fails to properly share in the employees' costs, you cannot get a group health insurance policy.
  
  

Medical Underwriting

• The majority of states permit insurance carriers to set the price for a group health insurance policy based, in part, on the medical history and current status of your LLC's participating employees. If the insurance company believes your group presents additional liability or higher financial risk, the premium for your coverage may be increased. Some states even allow insurance companies to outright decline an LLC's application for a policy if the medical underwriting reveals risks greater than the carrier is willing to assume.