Definitions: Small Group Special Enrollment Period

written by John McAndrew

Here are a few essential terms with which to start when learning about the Affordable Care Act (ACA) Special Enrollment Period:

The small group market is the health insurance market under which small employers offer health insurance coverage to eligible employees and their dependents.

A small employer employs fewer than 50 Full-Time-Equivalent (FTE) employees

FTE employee calculation uses the following formula:

______ all hours worked by part-time employees each month

/120      divide that number by 120


+_____ add the number of full-time employees paid each month


/12         divide that number by 12

=_____ Full-Time Equivalent (FTE) employees


Full-time employees, for the purposes of FTE calculation, are employees who work an average of 30 or more hours per week

Part-time employees for the purposes of FTE calculation are employees who work fewer than 30 hours per week.

Employee minimum participation is a minimum threshold of 75% of eligible employees enrolled for coverage through their employer.

Eligible employees are employees who are eligible (as defined by each company) to enroll in their employer’s company health insurance plan and are not otherwise insured, e.g., on a parent or spouse’s plan, Medicare, Medicaid, VA, or IHS.  See your company’s Human Resources representative or broker for more information.

Employer minimum contribution means employers are mandated to contribute a minimum of 50% of the lowest-cost premium for employees’ coverage. The minimum, if higher, is set by each state.