Q: I work for an employer who has fewer than 50 employees. Is my employer required to offer me health insurance coverage?
A: There is no federal or state law that requires an employer to offer health insurance coverage. The Small Employer Health Insurance Availability Act (SEHIAA) only governs the offer of coverage, IF an employer offers such coverage. SEHIAA does not require a small employer to offer coverage.
Q: Can exclusionary riders be placed on small employer coverage?
A: No. Under S.C. Code Ann. §38-71-1360 (3)(1976, as amended), it is stated: "(3) Except with respect to applicable preexisting condition limitation periods or late enrollees as provided in Section 38-71-850, a small employer insurer shall not modify a health insurance plan with respect to a small employer or any eligible employee or dependent through rider, endorsement, or otherwise, to restrict or exclude coverage or benefits for specific diseases, medical conditions or services otherwise covered under the plan."
Q: If a small employer is defined as a group of 2 to 50, can a husband and wife who are employed at the same business be considered a group of 2?
A: As long as both husband and wife meet the definition of "eligible employee" as defined in S.C. Code Ann. §38-71-1330 (F) (1976, as amended), and they each enroll as an employee, this would be allowed under the law.
Q: The insurance carrier is requiring that I produce reports showing hours that an employee worked and W-2 forms. Is this permissible?
A: Yes, the insurance company can require that a prospective employer produce records to make sure there is a true employer-employee relationship. Most companies are now requiring updated documentation before they will renew coverage.
Q: The insurance company is requiring that a certain percentage of my employees must participate in the plan. Only 3 of my employees want the coverage and the company is saying my company does not meet the participation requirements. Is this allowable?
A: Yes, a company may set participation requirements on the group. If your group does not meet the participation requirements, the insurance company will refuse to write coverage for your group.