Insurance Agent Forum

[Golddoor]

When running small group quotes and one of the employees is on Medicare. One is a full time worker but placed and paid by a staffing office. And some of the full time employees are on their spouses group plan already, do I have to include them in the census?

Thanks,

Golddoor

[Dave020]

No, certain things are valid waivers for group coverage and do not count against group participation rules.

The one's I can think of are:

Other group coverage (spousal or second job)
Medicare
Medicaid
Tricare (military dependents)

These people can decline group coverage without counting against the participation requirements for the group.

Dave
www.davefluker.com

[Golddoor]

Originally Posted by Dave020

No, certain things are valid waivers for group coverage and do not count against group participation rules.

The one's I can think of are:

Other group coverage (spousal or second job)
Medicare
Medicaid
Tricare (military dependents)

These people can decline group coverage without counting against the participation requirements for the group.

Dave
www.davefluker.com

Ok thats what I thought. Thanks Dave!!

[Dave020]

Originally Posted by Golddoor

Ok thats what I thought. Thanks Dave!!

de nada!

When you run your group quotes, usually the system asks the following (at least for me):

Number of employees
Number of employees eligible for quote
Number of employees enrolling

The second and third are the biggies when it comes to the participation requirements. So you might have something like:

25
17
16

Obviously you have 8 people declining coverage in favor of a legitimate waiver, 17 that cannot waiver, and 16 of the 17 are willing to enroll, so you should be good for the participation.

Dave
www.davefluker.com