The smallest groups run on the tightest rules. One waiver changes the participation math, a spouse on payroll may not count, and some carriers will not quote under a certain headcount. Here is how it actually works, and where the doors are open.
A business qualifies for a group health plan once it has at least one W-2 employee besides the owner who enrolls. That is the real floor. Solo owners with no employees buy individual coverage instead, and a spouse who is the only other person on payroll usually does not count as the qualifying employee.
From there the plan is guaranteed issue: no one on the team can be declined or rated up for health history. What decides your options is not health, it is participation (how many eligible employees enroll), contribution (how much of the employee-only premium you pay), and headcount (which funding models will quote a group your size). Fully insured plans quote any qualifying group. Level-funded carriers set their own minimums. An ICHRA works at any size with no participation rule at all.
We list every person on payroll and sort them: owner, full-time W-2, part-time, 1099. Contractors do not count toward a group plan. Part-time eligibility depends on the carrier and the state. Florida, for example, lets carriers treat 25 hours a week as full time, while the federal definition most carriers use is 30. This list decides whether you have a group at all.
A census is the enrolled list with ages and ZIP codes, not the payroll list. Employees covered by a spouse, a parent, Medicare, or Medicaid can usually waive, and documented waivers typically come out of the participation denominator. In a group of 6, sorting this correctly is the difference between qualifying and not.
Fully insured small-group plans quote any qualifying group and give you fixed premiums with full guaranteed-issue protection. Level-funded plans reward a healthy census with refund potential, but each carrier sets a minimum enrolled count, and some will not look under five or ten. An ICHRA has no minimum and no participation rule, which makes it a real option when a traditional plan will not fit.
You need one enrolled W-2 employee besides yourself. If your only employee is your spouse, most carriers treat that as an owner-only group and will not write it as group coverage. Hiring one part-time W-2 employee is how many solo owners cross the line, and the math often works out.
Most carriers want a majority of eligible employees enrolled, and some look for a specific percentage. With 4 eligible people and 1 waiver, you need the other 3. We tell you the exact number before you talk to anyone on your team, so nobody is promised a plan the group cannot support.
Several states, including Florida, run a special enrollment window late in the year when carriers must accept eligible small groups regardless of participation or contribution levels. If your group cannot hit the normal minimums, that window can be the way in. We track the dates.
Growing past 10? The rules loosen a little as the headcount rises, and level funding becomes realistic for more teams. Our guide for 10 to 25 employees covers that stage. For your state's carriers and rules, start from the state pages, and see the small business hub for the full menu of group structures.
Usually yes. Owner plus one enrolled W-2 employee is the standard floor for a small-group plan in most states, and the owner counts as an enrolled member. The employee has to be a real common-law employee on payroll, working enough hours to be eligible under the carrier's rules.
No. Contractors are not employees for group health purposes. If your team is mostly 1099, the individual market or an ICHRA-style arrangement for the W-2 staff you do have is the more realistic path, and we will say so.
Most carriers will not write a group that is only an owner and a spouse. Once there is at least one non-spouse W-2 employee enrolled, the spouse can join the plan like anyone else.
A majority of eligible employees, and often a specific percentage. Employees with other coverage can usually waive without hurting the ratio. We calculate this before quoting so you know the enrollment you need.
Three options. Raise your contribution so more people enroll. Wait for your state's guaranteed small-group window if it has one. Or look at an ICHRA, which reimburses employees for individual plans and has no participation minimum at all.
Send us the headcount, ages, and ZIP codes. We sort eligible from waived, tell you which funding models are open at your size, and price the ones that are, at zero cost to you.
Quotes are non-binding and based on the information you provide.