For Groups Headquartered Domestically

“Small employer” or “small group” means any person, firm, corporation, partnership, association, political subdivision, sole proprietor, or self-employed individual that is actively engaged in business that employed an average of at least one but no more than 50 employees, during the previous calendar year and employed at least one employee on the first day of the plan year, is not formed primarily for purposes of buying health insurance, and in which a bona fide employer-employee relationship exists. In determining the number of employees, companies that are affiliated companies, or that are eligible to file a combined tax return for purposes of taxation by this state, shall be considered an employer. Subsequent to the issuance of a health plan to a small employer and for the purpose of determining eligibility, the size of a small employer shall be determined annually. Except as otherwise specifically provided, a small employer shall continue to be considered a small employer until the plan anniversary after the date the small employer no longer meets the requirements of this definition. A self-employed individual or sole proprietor who is covered as a group of one must be a common law W-2 employee and:

• Have been employed by the same small employer or small group for at least twelve months before for small group coverage, and

• Verify that he or she derived at least 75% of his or her income from a trade or business through which the individual or sole proprietor has attempted to earn taxable income and for which he or she has filed the appropriate Internal Revenue Service (IRS) form 1040, schedule C or F, for the previous taxable year, except a self-employed individual or sole proprietor in an agricultural trade or business, must have derived at least 51% of his or her income from the trade or business through which the individual or sole proprietor has attempted to earn taxable income and for which he or she has filed the appropriate IRS form 1040, for the previous taxable year.

As of 2018, the owner or officer signing the employer group application for the group must be a resident for tax purposes in the state in which the group is applying for medical coverage.

One employee does not include sole proprietors. There must be at least one enrolled W-2 employee who is not an owner and not an owner’s spouse. Partners and LLCs filing as a partnership are eligible even if there are no W-2 employees. Self-employed individuals, sole proprietor, or corporations considered as group of one, must be employed for last 12 months.

Groups that do not meet the definition of a small employer are not eligible for coverage. Non-guaranteed associations, Taft-Hartley groups, professional employers organizations (PEOs)/employee leasing firms and closed groups (groups that restrict eligibility through criteria other than employment) and groups where no employer/employee relationship exists are not eligible.

Life, disability and dental have ineligible industries.

For Washington and Idaho, Aetna requires that 51% of the employees reside in the state where business is being written in.

For Groups Headquartered Internationally

The worldwide Headquarters/parent company must be located outside of the United States.

Employer (Companies/Organizations) must not be formed solely for the purpose of obtaining health coverage.

Non-Guaranteed associations, professional employers’ organizations (PEOs/employee leasing firms and closed groups (groups that restrict eligibility through criteria other than employment)), and groups where no employer/employee relationship exists are not eligible.

One employee does not include sole proprietors. There must be at least one enrolled W-2 employee who is not an owner and not an owner’s spouse. Partners and LLCs filing as a partnership are eligible even if there are no W-2 employees. Self-employed individuals, sole proprietor, or corporations considered as group of one, must be employed for last 12 months.

Groups that do not meet the definition of a small employer are not eligible for coverage. Non-guaranteed associations, Taft-Hartley groups, professional employers’ organizations (PEOs)/employee leasing firms and closed groups (groups that restrict eligibility through criteria other than employment) and groups where no employer/employee relationship exists are not eligible.