For group health benefit plans purchased outside of the SHOP marketplace, this form must be completed for new and renewing groups to determine whether a group qualifies as a small employer.
Controlled and Affiliated Groups means groups that are commonly controlled and/or affiliated as described in subsection (b), (c), (m), or (o) of section 414 of the Internal Revenue Code of 1986. If a group is a controlled or affiliated group of employers, a carrier must treat the group as a single group, and the controlled group must complete one group profile form.
Controlled Groups include parent-subsidiary, brother-sister, and the combination of both of the preceding.
Seasonal Workers
An employer is not considered to have more than 50 full-time employees (including full-time equivalent employees) if both of the following apply:
The employer's workforce exceeds 50 full-time employees (including full-time equivalent employees) for 120 days or fewer during the calendar year, and
The employees in excess of 50 employed during such 120-day period are seasonal workers.
In answering the questions about employees, an owner is generally not considered an employee even if the owner performs services for the business for compensation; however, an owner may participate in a group plan as long as the group employs at least one common law employee that is enrolled in the plan, and that offers the group health plan to all full time employees.
An Owner includes:
A sole proprietor and the sole proprietor’s spouse;
A member of a single-member limited liability company and the member’s spouse;
The owner of a wholly owned corporation and the owner’s spouse;
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QUESTIONS |
ANSWERS |
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1) Are you part of a controlled group? |
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2) If you are part of a controlled group, who is the employer for purposes of filing taxes? |
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3) How many FTs were in your group the prior calendar year? (If you are part of controlled group, this is the total FTs of the controlled group). |
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4) How many FTEs were in your group the prior calendar year? (If you are part of controlled group, this is the total FTEs of the controlled group). |
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5) What is the sum total of your answers to questions 3 and 4 above? If the answer is 51 or more, you are eligible for coverage in the large group market instead of the small group market. |
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6) For the purpose of determining eligibility, employers must have at least one benefit eligible and enrolling common law employee at the time of enrollment (i.e. not an owner or spouse of owner). How many enrolling common law employees, excluding owners and spouses of owners, will be in your group as of the effective date of coverage? |
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7) How many benefit eligible employees will be in your group as of the effective date of coverage? |
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