Kaiser Permanente Small groups with effective dates from September 1, 2018, to January 1, 2019, will only need to meet 50% health plan participation rate instead of 70%. This means only 50% of eligible employees will need to be covered by a group health plan to offer Kaiser Permanente.

The basics:

  • Minimum participation rate is 50% of eligible employees are covered in a group-sponsored health plan for new business.
  • We’ll continue to write small groups with one enrolling subscriber.
  • There’s no change to our counting methodology for valid waivers.
    Example: A group of 6 with 2 enrolling with KP, one declining for spouse’s employer plan and 3 waiving. Does this group qualify?
  • Yes! This group has 50% in a group-sponsored health plan; 3 in a group sponsored plan, and 3 waiving = 50%.

An employee is considered to have a group health plan and count toward the 50% participation rate requirement when:

  • They enroll in a Kaiser Permanente plan offered by the group.
  • They decline coverage due to enrollment on another group health plan.

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