Groups of One
Under federal law, employer group plans are defined as those sponsored by firms with two (2) or more employees. In a number of states, however, group health insurance has been defined more broadly to include "groups of one," that is, self-employed individuals with no other employees.
For additional information on coverage for groups of one within health care reform, please visit http://www.healthcare.gov/small/self-employed/index.html.
How can I get health insurance as a group of one?
In states that offer this coverage, self-employed persons can gain access to policies sold to other small employers and enjoy some or all of the legal protections that attach to those policies. Specifically, small employers must be sold coverage on a "guaranteed issue" basis. That is, they cannot be turned down by insurance companies because of the health status of anyone in the group.
Also, in these group-of-one states, rating limits apply to the premiums that can be charged to small employers including groups of one. By contrast, in most state individual health insurance markets, consumers can be turned down or charged substantially more for coverage based on their health status.
In addition, under federal law, a special tax deduction is available to self-employed individuals who purchase their own health insurance.
How can I find out if groups of one are recognized in my state?
Please contact your state insurance commissioner's office to find out whether insurers in your state offer health insurance policies for groups of one. Contact information for state insurance departments is available at http://www.naic.org/state_web_map.htm.
This information was drawn from "Health Insurance Resource Manual" prepared for the American Diabetes Association by Georgetown University's Health Policy Institute, ©2003, Georgetown University. All rights reserved.
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