Group Coverage Eligibility for 1099 Employees

Optima Health is now offering more opportunities for individuals to enroll in group coverage.

Beginning with new and renewing groups with an October 1, 2018 or later effective date, Optima Health Small Group employers (50 or less total employees) may include 1099 employees on the group health plan.

1099 Eligibility and Attestation Form

The following criteria must be met:

  • 1099 employees cannot exceed 50% of the group’s total eligible employees.
  • All 1099 employees must be employed year round, on a full-time basis.
  • 1099 employees are subject to the same eligibility and waiting-period requirements, as well as employer contribution amounts, as W-2 employees.
  • At least two W-2 employees must be enrolled in coverage.
  • Employers must provide verification documentation:
    • For 2018: Complete an Eligibility and Attestation Form, and submit with the census and other required paperwork. This form is also available in eBroker.
    • For 2019: Complete the Eligibility Requirements for Groups Covering 1099 Employees section of the 2019 Employer Group Application.

Please contact your Optima Health representative to confirm eligibility or if you have any questions.