Plan Management Guide

Small Employer | 2026

Medical Plan Requirements and Exclusions 

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Small Employer ACA


Employer monthly contribution 

Small employers must contribute an amount equivalent to at least 50% of the employee-only rate on the lowest-cost plan offered by the employer. This contribution must be consistent for all employees in a given class. 

Required minimum employee enrollment 

Employees waiving coverage will not be counted toward participation if they have other comprehensive medical coverage. For employers with up to four eligible employees after valid waivers, 100% must participate. For employers with five or more eligible employees after valid waivers, 75% must participate. Valid waivers include having coverage through another carrier, valid individual medical coverage, coverage through Medicare or another government program, or coverage through a spouse or parent. Coverage through a short-term plan, med share plan, critical illness only, etc. are not valid coverage for waiver.

Groups that are new to Select Health are not subject to participation or contribution requirements if they do the following: 1) enroll for a January 1 effective date and 2) submit enrollment no later than December 15. 

Level Funded


Employer monthly contribution
To secure the best possible rates, Level Funded employers should contribute an amount equivalent to at least 75% of the employee cost or 50% across all tiers of the lowest cost plan they offer. This contribution must be consistent for all employees.

Required minimum employee enrollment

Minimum recommended participation is 75% of eligible employees after valid waivers are removed. Increased participation will normally result in improved rates. Valid waivers include having Minimum Essential Coverage (MEC) through another carrier, valid individual medical coverage, coverage through Medicare or another government program, or coverage through a spouse or parent.

Excluded services

All plans are subject to exclusions and limitations. A complete list of exclusions will be included in the Summary Plan Document and in your employees’ member materials.

Qualifications for a Level Funded group

To be considered for a Level Funded plan, there must be 15 or more employees enrolling. Eligible employees are those who work 30 or more hours per week for the insured group.

Associations


Required minimum employee enrollment

Employees waiving coverage will not be counted toward participation if they have other comprehensive medical coverage. For employers with five or more enrolled employees, 75% enrollment participation is required after valid waivers. Valid waivers include having Minimum Essential Coverage (MEC) through another carrier, valid individual medical coverage, coverage through Medicare or another government program, or coverage through a spouse or parent.

Select Health does not allow another health plan to be offered in addition to a Select Health Small Employer plan. If a group is contracted for a Select Health Small Employer line of business, they are only allowed to offer the Select Health plan and no other carrier. This includes participating in Healthcare Sharing Ministries (HCSMs), a self or level funded plan, etc. Select Health does not allow additional carrier coverage even if another carrier does.

Excluded services 
All plans are subject to exclusions and limitations. A complete list of exclusions will be included in your employee member materials. A list of common exclusions can be found at selecthealth.org/disclaimers/member-rights-responsibilities.