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Eligible Employees

One of the five initial qualifications for coverage under the WV Small Business is that "75% of eligible employees must participate." What does that mean?

In general, an eligible employee is someone who does not have health insurance coverage through any other means, such as being under a spouse's policy. For example, if a company has 20 employees and 4 of those are covered by their spouse's insurance plan at another business, 16 employees would be considered "eligible." Of those 16 eligible employees, 75% must purchase coverage, which would be 12 people.

In other words, if an employee has health insurance through another means, they are not considered "eligible" and they are exempt from the pool of "eligible employees."

What if some employees have individual policies? Are they considered eligible to buy under the WV Small Business Plan?

In general, such employees would be eligible for coverage under the Small Business Plan. Individual coverage is not the same as a "company-sponsored health plan."

Another of the five initial qualifications is that a business "has been without company-sponsored health insurance for the past 12 consecutive months." Since individual coverage is not a company-sponsored plan, persons who have had individual insurance will qualify under the Small Business Plan.

For additional information on eligibility, please contact a local insurance agent who is offering the West Virginia Small Business Plan.