How many employees do you need to qualify for group health insurance?

For many companies and organizations, group health insurance provides operational savings and great coverage options for employees. In order to use these plans, however, you need a certain number of people working for the business. If your business is very small, you may not think that you have enough people to take advantage of these plans with potentially lower rates. After you know the facts, you might be pleasantly surprised.


Small Business Definitions


Two main determinations matter when you consider if your small business is eligible for group health services or not. First, how many employees do you have? Second, are they related to you? The answers to these questions determine whether you can get group health insurance and if you qualify for small or large group versions.


If you have less than 50 workers employed full-time at your company, you qualify as a small business when it comes to purchasing and providing health insurance benefits. However, if you have only a few and they are all family members, will have to use a family insurance plan instead. This also applies if the other employees own part of the business along with you.


Any company with 50 or more employees can definitely choose group health insurance. However, they will not get the small business version as long as all other criteria are met.


Employee Qualifications for Group Coverage


Besides not being direct family members of the owner of the business, there are other rules about who constitutes an employee for group health insurance allowances. In general, any full-time employee counts. Part-time employees do not count on their own. However, the IRS has developed a guideline that allows you to add together multiple part-time employees to create what is called a full-time equipment one. If you have two workers who both work 20 hours per week, they will add up to one full-time employee.


The cut off for full-time work is considered 30 hours per week. If you want to offer group health insurance at your company, it makes sense to pay attention to how much work is being done by the majority of the people employed there.


There are a wide variety of different types of group health insurance you can get on the market today. Besides for traditional HMOs and similar, there are also alternatives like MEWA, VEBA, and more. It may be difficult to navigate the complex issues surrounding the healthcare industry today. Since you have to pay attention to the rules still in place under the Affordable Care Act, it may help to get some group health consulting services to better navigate your options.


ClaimLinx can help you do just that. We offer qualified and services about a wide variety of different health plan options. We will help you determine if your employees qualify and whether you can get small business group health plans or larger group coverage. Let us help you make the best choice for your company.


Save Big on Your Next Prescription

Prescription prices go up all the time, and it can be difficult for people to afford all the medications they need on a regular basis. If you want to help your employees save big on their next prescription, you need to find the best possible solution. ClaimLinx consulting services stands ready to help you make the best decisions about the health insurance benefits you offer to every employee.


The high costs of prescribed medications in the United States today have left many employed individuals without the treatments they need for chronic and acute illnesses and conditions like high blood pressure, general anxiety disorder, and diabetes. Not only does this failure affect physical health and well-being, it can also negatively affect your company’s workforce in the long run. To protect every worker and your bottom line, find the best way to help them save big on their next prescription.


How Can Employees Save on Every Prescription?


Ultimately, the more coverage a health insurance plan offers, the lower the costs for prescription medication will be. However, providing this type of benefit as a small or medium-sized business can present a financial challenge. ClaimLinx consultation services help you make sense of your options and provide the best balance of affordability and coverage to serve both your company and every person who works at it.


Usual recommendations for how to save big on your next prescription include:


  • Opt for generic versions of the same drugs
  • Choose stronger pills and higher quantities that can be split into appropriate doses
  • Use regular market or big-box store pharmacies
  • Update your medical coverage plan or look for prescription supplements


These four methods help average people spend less on the drugs they need. They are all excellent ideas that you can recommend to your employees three human resources pamphlet or health coverage package insert.


The ClaimLinx Simple Option takes things further by minimizing out-of-pocket costs for workers who need prescription medications to get over an illness or manage a chronic health issue. It also provides lower monthly costs for the company who offers the benefits directly. When this is combined with an effective medical expense reimbursement plan (MERP), the end result is additional savings for everyone.


This multifaceted savings plan benefits everyone who needs to save money on their next prescription or wants to support those who need them to survive and thrive. Health insurance coverage has so many options these days that it can become quite complicated to understand. With ClaimLinx consulting, you can take advantage of the experience and industry information to make informed decisions about appropriate prescription coverage. Our services have saved companies 20% or more without compromising the health of any employee.


Contact us online or give a call to talk about how we can help your workers afford the healthcare medications they need without compromising your profit potential with extra benefit costs.


Medicaid, Medicare, Health Insurance

The people who work for your company need the best health insurance possible at the most affordable prices to maintain proper medical care and prescription coverage for themselves and their families. Many workers in the United States use Medicaid, Medicare, health insurance plans from major carriers, or have other types of supplemental assistance. These things can cover doctor’s visits, hospital stays, treatment plans, and medication for a wide variety of reasons.


However, the costs associated with these health coverage options are sometimes prohibitive for regular workers on your payroll. ClaimLinx offers benefit consultation services to help you maximize what you can offer employees to keep them healthy and satisfied. This holds true no matter what type of health insurance you offer or if they use Medicare or Medicaid services.




This state and federal joint medical coverage program primarily helps lower income individuals who do not have access to or qualify for other types of health insurance. Some part-time or underemployed workers qualify for Medicaid coverage and make use of it every day to get proper healthcare, cover prescription medications, and take care of catastrophic needs.


As an employer who wants to provide essential benefits for every worker, getting help from ClaimLinx when it comes to finding the most affordable healthcare options can provide a positive solution to Medicaid.




Although mostly retired people use Medicare health benefits, older Americans who still work at a full or part-time job make use of this federal program, too. This program is available to people 65 years of age or older and those with either temporary or permanent disabilities. If their employer offers health insurance, Medicare becomes a secondary payer to cover medical expenses that they would otherwise have to pay for out-of-pocket.


In most cases, an employer has little to do with a person’s Medicare claims. However, it is important to understand if any of the people who work at your company use the government program to supplement existing health care. All of this information is factored into the ultimate decision about which group health insurance plan to get, what coverage you should offer, and whether you can save money on existing plans or not.


Health Insurance


Full-time employees must receive some form of health benefits from companies of a certain size. Your business may also choose to offer insurance plans outside of the legal requirements. However, the last thing you want to do is pay extra or create higher costs for the people employed by your company. 


Traditional health insurance plans from major carriers are not the only solutions. As a company who employs people full-time, you are required to offer coverage of certain types. With professional guidance and a full understanding of Medicaid, Medicare, health insurance and current regulations, you can change how you approach your benefit plan.


ClaimLinx services offers solutions that allow everyone to benefit. Contact us as soon as possible to make sure your existing plan is as affordable and effective as possible or to change to a different coverage type offer even more benefits to the people who count on you every day.


What are the Qualifying Life Events for Health Insurance?

Every year, people all across the United States have an opportunity to change their health insurance in an open enrollment period. When it comes to small business insurance, the options may not include as many possibilities as your employees may like. Also, if any of them have experienced a distinct change in their health or diagnosis of a specific condition, they may benefit from an earlier change in insurance coverage.


This requires what are known as qualifying life events. These situations affect insurance availability and an individual’s ability to make decisions about the health plan they use.


What Are Qualifying Life Events?


Any type of change that triggers issues with access to small business insurance coverage probably fits the definition of a qualifying life event. These can trigger a special enrollment period (SEP) so individuals and families can choose new benefit options that suit their dynamic needs.


Health Insurance Coverage Loss


If a person loses health coverage for any reason due to accessibility or eligibility, they can seek out new insurance right away. These situations include turning 26 years old and being no longer included on a parent’s coverage plan, leaving a job that provided insurance, or changing financial circumstances that removes eligibility for Medicaid or Medicare.


Moving Residences


Changing states, cities, and ZIP Codes can affect health insurance availability. Qualifying life events include a university student coming home from school, seasonal workers shifting to a new location, or any other type of voluntary move. In many cases, these types of moves also include job changes, which are one of the most common causes of switching insurance carriers or programs.


Household Changes


Small business insurances that operate family plans or package deals depend on maintaining the same household structure. If this changes through marriage, divorce, birth, adoption, or a death, health benefits may no longer exist. This is considered a qualifying life event that allows for new plan choice and enrollment outside the usual time period.


Unique Qualifying Life Events


The designation of a qualifying life event is rather flexible so people do not have to go without health insurance for long if things change considerably. Other possibilities include income changes, achieving citizenship, getting out of prison or jail, and coming back from overseas temporary work or volunteer services. 


The system’s goals are to keep as many people covered by health insurance is possible at all times. If one or more of these situations affects a person’s life, financial status, or residence, they still have the option to get coverage outside of the usual enrollment period.


While employees that work for your company may decide to make these decisions on their own, as a small business owner, you need to be aware of their needs and providing options that suit dynamic situations. Doing all the research on your own is cumbersome and time-consuming. Instead, opt for insurance consulting from experienced professionals who understand qualifying life events and the possibilities that exist to satisfy your employees’ need for proper health coverage.

Employers: call us for help cutting costs to get through “stay at home” orders

As of Monday, March 23, 2020, the Ohio Governor issued a mandatory “stay at home” order. It comes on the heels of previous business closures because of social distancing guidelines. Like in many states, the order will continue until the beginning of April. It’s all in hopes of stopping the spread of the novel Coronavirus.

But for many businesses it’s already causing severe financial pain.

Remember, ClaimLinx’s primary concern is savings clients money on health insurance. We know how important health coverage is, especially at a time like this. Our consultants are ready to talk you through how to cut employers’ health insurance costs. We know it’s more important now than ever.

Please contact or call (513) 985-4465 to set up a meeting if you are considering laying off employees or cutting their hours.

Changes to Claimlinx’s Service

The mandatory “stay at home” order in Ohio, where Claimlinx’s main office is located, began on Monday, March 23 and will continue until April 6. Claimlinx employees are able to continue working remotely, but we are making some adjustments to our mailing services.

Because we are an Insurance Institution, we are considered an essential business, as outlined in the order. So we will still have some employees going to our office to maintain services. But we are limiting this as much as possible. For that reason, we do anticipate some delays in mailing. 

We expect this primarily to impact mailing explanations of benefits (EOBs) and member ID cards. Temporarily, we will be sending all member ID cards digitally first and sending a hard copy later. Members can always contact if they need a copy of an EOB.

Related post: Changes for members during Coronavirus “stay at home” order

Contact us before cutting employees’ hours

Already we have had clients who are considering placing employees on furlough or moving them to part time. Our consultants already have strategies for how to use this time to cut costs while still providing benefits.

We are here to help companies get through this trying time. Many employers are worried about how long the pause in the economy will last and what affect it will have on their bottom line. We know, too, they are worried about their workers.

Contact or call (513) 985-4465 to set up a meeting. Our consultants will go over your immediate options and any other long-term planning that may be needed.

Some employers may be able to take advantage of already existing rules on coverage to save on insurance premiums in the coming months. Some employers may need to stop providing insurance for any employees who are laid off. We would like to be there to offer our services to help these people navigate the marketplace so they don’t experience any lapses in coverage.

ClaimLinx is here for all of its clients, especially when trying to cut costs because of financial strains.