Insurance is regulated at the state level, so every state's rules are slightly different. However, regardless of the state in which you live, no employer can force you to participate in a group health insurance plan. Understanding the requirements for creating and maintaining a qualified group can help you make proper decisions regarding your employer's insurance plan.
Eligibility Requirements
To be eligible to participate in your employer's health plan, you must meet your state's criteria regarding the number of hours worked and how long you've been employed. If you don't work enough hours or are a new employee, you cannot participate.
Participation Requirements
Employers are required to offer the health insurance plan to every eligible employee. However, if too many workers decline without credible coverage elsewhere, the plan cannot be implemented.
Eligible Waivers
Workers who decline to participate in an employer's plan can be exempt from participation requirement calculations if they are an "eligible waiver," meaning they are already covered by another group health insurance policy through a spouse or other company.
Open Enrollment Periods
Health insurance carriers typically only permit new signups or changes to a group plan once per year during the open enrollment period. If you fail to enroll during this window, you will be unable to enroll until the following year.
Live Events
If you decline your employer's group coverage but later experience a "life event" such as a birth, death, marriage, or divorce, you can enroll immediately after that event regardless of the open enrollment period.
