§10753 Non Grandfathered Plans (f) “Eligible employee” means either of the following:
(1) Any permanent employee who is actively engaged
CA DOI Bulletin 94-9A: “Actively at Work” or “Not Disabled”
on a full-time basis in the conduct of the business of the small employer with a normal workweek of an average of 30 hours per week over the course of a month, in the small employer’s regular place of business, who has met any statutorily authorized applicable waiting period requirements. The term includes sole proprietors or partners of a partnership,
[But it doesn’t allow them to be a 1 employee – employer?
See last line of Employer definition 10753 q 1 – only to extent required by PPACA ]
if they are actively engaged on a full-time basis in the small employer’s business, and they are included as employees under a health benefit plan of a small employer, but does not include employees who work on a part-time, temporary, or substitute basis. It includes any eligible employee, as defined in this paragraph, who obtains coverage through a guaranteed association. Employees of employers purchasing through a guaranteed association shall be deemed to be eligible employees if they would otherwise meet the definition except for the number of persons employed by the employer.
A permanent employee who works at least 20 hours but not more than 29 hours is deemed to be an eligible employee if all four of the following apply:
(A) The employee otherwise meets the definition of an eligible employee except for the number of hours worked.
(B) The employer offers the employee health coverage under a health benefit plan.
(C) All similarly situated individuals are offered coverage under the health benefit plan.
(D) The employee must have worked at least 20 hours per normal workweek for at least 50 percent of the weeks in the previous calendar quarter.
The insurer may request any necessary information to document the hours and time period in question, including, but not limited to, payroll records and employee wage and tax filings.
(2) Any member of a guaranteed association as defined in subdivision (s).
Participation rules – % of employees required to be on a group health plan
Child & Related Pages
- 1099 vs Employee & Other Defintions
- Dependent Definition – Up to Age 26
- Bonifide Employer-Employee Relationship – non spousal
- EmployEE Definition
- HR 1624 Federal Repeal 51 to 100 Definition
- Self Employed – Group Health Insurance
Technical Links & Resources
ABX1-2 Pan 5.2013 Brings CA into compliance with Health Care Reform