What Are Employer Group Health Insurance Requirements?

Here are the most crucial Employer Group Health Insurance Requirements: 1. The minimum number of employees:- According to IRDAI, minimum of 7 or more employees
Team Loop Health
June 10, 2021

Challenges like financial issues, healthcare costs, and troubled mental wellbeing exposed by the COVID-19 pandemic reached a new critical level. With the link between workplace productivity and stress, as an employer, it’s in your best interest to make sure your workforce has all the pertinent resources to feel supported and safe. Proactive preparation will ensure you protect your business to weather the storm as well as maintain top-line growth.    

Group health insurance (GHI) is something that will give you peace of mind plus, it’s a future-proof approach to healthcare and benefits. To secure a comprehensive healthcare solution that rightly aligns with your company, your organization needs to meet some group health insurance requirements. Any small group or organization must meet these requirements.

Let’s take a look at employer group health insurance requirements.

Who Is Eligible For Group Health Insurance?

Typically, group health insurance plans are employer to employee. However, non-employer to employee groups are eligible too.

So, whether you’re a small business owner or large-scale organization, emerging start-up, or a group with a common interest, you can get group health insurance, provided you meet the employer group health insurance requirements.

Those who meet the following criteria are eligible for Group Health Insurance.

1. The minimum number of employees for group health insurance - According to the Insurance Regulatory and Development Authority (IRDAI), a minimum of 7 or more employees must be present in a business/enterprise/organization to apply for group health insurance. Employees can be family members as well, say a family business. But, the employer-to-employee relationship must be present.

2. Registered business - You need to officially register your business and you need to have the appropriate paperwork as well as possess a GST number.

Note: Group health insurance premiums are cheaper and so, you cannot form a group/business for the purpose of purchasing insurance. This can lead to the refusal of insurance by the insurer. Ideally, the business should already be engaged in economic activity and not begin work after enquiring about group health insurance.

Who is Not Eligible for Group Health Insurance?

As with every insurance, group health insurance also has certain limitations. If your organization falls under any one of these categories, you will not be eligible for group health insurance.

a) Single entrepreneur

If you’re a single entrepreneur with no full time equivalent employees, you’re not eligible for corporate health insurance. However, you can apply for individual health insurance plans to ensure you’re protected.

b) Family business

Under family business, if the family business is made up of both family members and non-members then the spouse is eligible for group cover. If the business group consists of only family members, typically the spouse is not covered.

Exceptions for Group Health Insurance

a) Eligible dependents

Group health insurance cover eligible dependents. The employer or non-employer can either contribute to cover the cost of dependents or allow employees to pay an additional premium to include dependents in their policy.

b) Certain companies who otherwise wouldn’t qualify for corporate health insurance can make the cut because of specific group dynamics. Like those who work with part-time or contractual workers can apply for group health insurance.

c) If an organization has a majority of its employees over the age of 65, it’s a special case and they can qualify.

What If The Number of Employees Reduces After the Policy is Issued?

Let’s assume you had 8 employees when you purchased the group health insurance. All of a sudden, one employee decides to switch jobs. Now what?

Luckily, there’s no reason to fret. Such limitations are only applicable when you purchase your policy. Thus, your present policy will continue as it is until the time of renewal. Such considerations will be accounted for only during renewal.

However, at the time of renewal, the insurer can make room for certain relaxations like insuring 6 employees for a marginally higher premium.

Group Health Insurance Plan By Loop Health - Your Team’s Way To Navigate The Road Ahead

We hope you have a strong understanding of the employer group health insurance requirements.

As a business owner, an HR, or manager, your agenda is chock-a-block. You’ve got plenty to do and which is why you can leave your health insurance needs to Loop Health while you focus on your goals.

Loop Health provides excellent, cost-effective group health insurance plans for your business.

We ensure the holistic wellbeing of your employees with comprehensive medical coverage including value add-ons like free OPD care, discount on lab tests, wellness plans, mental and dental cover. Plus, with customized groups health plans, you have choices in building a healthy, engaged workforce.

And with us being with you every step of the way, you’ll have the best-in-class group health insurance experience.

Interested to offer health insurance for your employees?

I’m ready to sign my business up for healthy tomorrow!

Want to learn more about Buying Group Health Insurance? Click here

Employer Group Health Insurance Requirements FAQs:

Below are some of the most frequently asked questions about employer group health insurance requirements.

1. Can husband and wife have group health insurance?

If both the husband and wife run a family business and are seeking a group health insurance plan, the wife or husband cannot usually count as the company's sole employee. Instead of being a sole proprietor, the wife or husband can join the group health insurance plan if the company includes two more working employees (who may or may not be family members).

2. How many employees do I need for group health insurance?

A minimum of 7 or more employees are required to apply for small business health insurance.

3. Do employers provide group health insurance coverage for part-time employees?

Part-time people are entitled for group health insurance, but whether they receive it is up to the employer. Because providing group health insurance to part-time employees is not really a legal obligation.

4. Is group health insurance mandatory for employees?

The pandemic, of course, changed everything. It even impacted the company's perspective on group health insurance. Because, in the case of group health insurance, companies should be proactive in ensuring that their employees are in healthy condition.

Following the Covid-19 lockdown, the government mandated that all businesses provide group health insurance to their employees.


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