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Las Vegas Group Health Insurance Eligibility Requirements -
Typical Rules
Fifty-one percent of all eligible employees
must be employed in the state of Nevada. If no state has a
numerical majority and the group is headquartered in Nevada,
then Las Vegas Nevada Small Group regulations apply.
a. The group must have a physical location
in Nevada.
b. Group size 2-50 with one enrolling:
Nevada does not recognize a group with more than one
employee when only one enrolls as a small group because the
group will not meet the minimum participation requirements
in Nevada. Small employer means with respect to a calendar
year and a plan year, an employer who employed on business
days during the preceding calendar year an average of at
least 2 employees, but not more than 50 employees, who have
a normal workweek of 30 hours or more, and who employs at
least 2 employees on the first day of the plan year. For the
purposes of determining the number of eligible employees,
organizations which are affiliated or which are eligible to
file a combined tax return for the purposes of taxation
constitute one employer. Organizations are “affiliated” if
one directly, or indirectly, through one or more
intermediaries, controls or is controlled by, or is under
common control with, the other, as determined pursuant to
the provisions of NRS 692C.050.
c.
Eligible employee means a permanent employee who has a regular working week of
30 or more hours. The term includes a sole proprietor or a partner of a
partnership, if the sole proprietor o r
partner is included as an employee under a health benefit plan of a small
employer.
Employer / Employee Relationship
a. An employer/employee relationship must
exist. An employee who works at least 30 hours per week is
considered a full-time employee. An employee who works less
than 30 hours per week is considered a part-time employee
and isn’t eligible for coverage.
b. Persons that the employer compensates on
a 1099 basis are eligible for coverage. Here are the typical
eligibility requirements for groups with 1099 employees:
• Depending on the carrier no more than
10-50 percent of the group’s employees can be 1099
employees.
• The 1099 employees must be employed by the
company full time and year round.
• All present and future 1099 employees are
subject to the same eligibility requirements as taxed
employees.
• The employer must contribute the same
amount for 1099 employees as for all other employees
qualifying under NRS 689C.
• The employer must have at least two taxed
employees, with tax documents that verify the company is a
valid business.
• The new group submission must include a
complete list of all 1099 employees and other requirements
may be necessary, depending on the carrier chosen.
c. Temporary, seasonal, part-time and
substitute employees aren’t eligible unless they meet
eligibility requirements.
d. If an owner believes the structure of
his/her holdings produces a single employer-employee
relationship, most carriers require copies of all associated
supporting documentation validating 51 percent common
ownership of all companies involved. This documentation can
be submitted before the case submission. Nevada Health
Insurance Carriers make the final determination about
whether or not there is one responsible employer.
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