X-Ell Employee Benefits, LLC

1680 Route 23 North, Suite 310, Wayne, NJ  07470

Eligible Employees

 

 

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NJ Small Employer (2-50)

Reform Law Summary

Eligible employees are generally considered as those actively at work and averaging at least 25 or more hours per week.  Those working 25 or more hours are "full-time" for purposes of insurance eligibility.

 

To be considered eligible, the employee must receive "formal" compensation for his/her duties.  The law currently states that the employee must be a "bona fide" employee and permits a carrier to collect any pertinent information from the employer to substantiate this status, including payroll records.  The most commonly requested information is the employer's quarterly tax form WR-30.  For employees not listed on the employer’s WR-30, alternate proof of income and employee status is usually requested by the carrier and may include, but is not limited to: 1099, W2/W4 copies, schedule C, and/or articles of incorporation. 

 

Independent contractors are considered to be eligible, at the employer's discretion, if they work exclusively for the employer, even though they may receive compensation via 1099.  (NOTE: if the employer does not choose to cover independent contractor's, this will not effect the group's participation requirement – see "Participation." )

 

Retirees are only considered eligible for coverage if the employer had an established pension arrangement in place prior to January, 1994, and provided those benefits without discrimination to all those employees who qualified.  The pensioners had to have been covered under the employer's previous group health plan. 

 

Employees on a temporary work visa from a foreign country are considered eligible for coverage if they meet the regular requirements, even though they may not have a social security number.  They also do not need to be considered U.S. citizens.  Check with the respective carrier for required documentation (passport, work visa, green card, etc.).

 

Employees belonging to welfare negotiated unions (e.g., Teamsters, Local 1262, etc.) are not considered eligible and are excluded from the minimum participation calculation.

 

Temporary employees are not considered eligible provided that they are leased by a staffing agency.

 

Part-time employees – those working under 25 hours per week - are not eligible for coverage as defined by law.

 

Seasonal employees will be considered eligible is they work 25 hours per week for more than six months.