Ontario Group Insurance
Group Health Insurance is the most crucial part of a benefits package. It is no secret that in our current environment, it has become a challenge for small employers in Ontario to maintain affordable health coverage for their employees due to ever increasing costs.
Eligibility Requirements: The Nuts and Bolts!
In order to be considered for group health coverage, a carrier will require that there be a minimum of two employees. The eligible employee is one who works on a full time basis with a normal work week of 25 or more hours for compensation. Each year an employer should verify that his group still meets the eligibility requirements for group coverage. A health insurance carrier reviews the application for compliance when a group starts a new plan, and may audit each year at renewal by requesting a certification form verified with a WR-30.
The following items are also necessary for compliance:
- At least 75% of the employees must be employed in Ontario
- Only 25% can waive coverage without having other coverage elsewhere
- The employer must pay at least 10 % of the premium
- The employer has the right to decide on a waiting period for new employees to enroll in the plan – 0 to 6 months in Ontario
COBRA or Insurance after work:
COBRA (Consolidate Omnibus Budget Reconciliation Act of 1985) requires businesses to extend their group health insurance coverage to an employee who leaves or is terminated for reasons other than cause. The employee must pay the premium to the employer, who in turn includes it with his monthly payment to the company.
In Ontario, companies with two to nineteen employees must continue to provide coverage for twelve months after termination. The coverage must also be offered to the employee’s spouse and child. All potential beneficiaries must apply for continued coverage within 30 days of termination.