Group Health Insurance Eligibility Checker
Flag the small-employer facts that should be sorted out before you ask for group health insurance quotes.
This checker is not an eligibility determination. It is a pre-call screen for the questions that frequently derail small business health insurance conversations: owner-only businesses, spouse-only groups, one W-2 employee, 1099 contractors, part-time workers, remote employees, and state-specific carrier rules.
Screen your group facts
Results also update automatically as you change the fields.
What to gather before a broker call
Employee census
Names do not need to be part of early planning, but age, ZIP code, full-time status, dependent interest, and waiver likelihood help a broker quote accurately.
Payroll classification
Separate owners, spouses, W-2 employees, 1099 contractors, part-time workers, and seasonal staff. Do not assume they all count the same way.
State footprint
Remote or multi-state employees can change whether a single local group plan is practical and may make ICHRA worth comparing.
How to use the result
If the checker flags owner-only, spouse-only, one-employee, contractor, or multi-state issues, handle those before comparing premiums. Otherwise you can waste time reviewing plans that your group cannot use or that do not cover the employees you care about.
If the result looks conventional, that does not mean coverage is guaranteed. It means the next conversation can focus on premiums, networks, contribution, participation, SHOP, and alternatives rather than basic group structure.
Related pages
Example use case
A business owner says the company has “three people,” but one is the owner, one is the owner’s spouse, and one is a 1099 contractor. That is a very different conversation from a company with three unrelated full-time W-2 employees. The premium question should wait until the broker understands the group.
This is why the checker starts with classification instead of cost. Once the group facts are clear, the employer can move to quotes, SHOP questions, contribution strategy, or HRA alternatives with much less wasted time.
Do not treat a clean screen as approval. Treat it as a sign that the next broker call can focus on plan options instead of basic group structure.
What the checker is meant to catch
The checker is designed to catch the issues that often derail an early quote conversation: owner-only businesses, spouse-only groups, 1099 workers counted as employees, part-time workers treated as full-time, or employees spread across states.
If the answer is uncertain, that does not mean coverage is impossible. It means the next conversation should be with a broker or official marketplace source using the exact facts: business structure, W-2 employee count, hours, ownership, state, and who would enroll.
Do not use the result to promise coverage to employees. Use it to prepare the questions that determine whether a traditional small-group quote, SHOP path, HRA, PEO, or individual-market approach deserves the next look.
When the checker says “ask a broker”
That result is not a failure. It usually means the facts are too close to an eligibility edge case for a general tool: owner-only status, spouse involvement, workers in multiple states, or contractors who may not count as employees.
Use the result as a screening conversation
Eligibility questions are easy to oversimplify online. The checker is meant to flag what to ask next, not to give a final legal answer. A one-employee group, owner-and-spouse business, contractor-heavy company, or remote team can all require more careful review than a simple employee count suggests.
The best use of the result is to prepare a broker conversation. Bring the W-2 count, owner roles, spouse or family employment details, contractor count, part-time rules, and employee locations. Those facts help a broker determine whether traditional group coverage, SHOP, individual coverage, or an HRA path should be explored.
Official sources to verify
Rules and costs can change by state, plan year, employer size, coverage design, and tax treatment. Verify current details before acting.
- HealthCare.gov small-business coverage and SHOP resources
- CMS SHOP overview for employers
- IRS small business health care tax credit and SHOP marketplace
- KFF Employer Health Benefits Survey