Who Is Eligible

Eligibility Guidelines

You are eligible for Covered California for Small Business if:

• You have at least one but no more than 100 eligible employees and meet certain contribution and participation requirements.

• You have at least one employee who receives a W-2.

• The majority of your eligible employees live in California.

You are eligible for Covered California for Small Business if you have 100 or fewer full-time-equivalent employees.

If you are a sole proprietor, with no W-2-receiving employees, you may be eligible to purchase coverage through Covered California’s individual marketplace.

Employees who are not eligible for coverage include those employees who work less than 20 hours per week, receive a Form 1099 or are seasonal or temporary employees.

What is a full-time-equivalent employee?

For the purposes of determining whether an employer is a small or large employer as defined by the Patient Protection and Affordable Care Act and applicable California law, the employer is required to calculate its total number of “full-time-equivalent” (FTE) employees. This number determines whether the employer is eligible to participate in Covered California for Small Business

An FTE employee is not an actual employee, but a calculation involving all part-time and full-time employees who worked during the preceding calendar year (or who are reasonably expected to work in the current calendar year if the employer did not exist in the prior year). If the final figure exceeds 100, then the employer is a large employer under California law. For coverage starting Jan. 1, 2016, if the final figure is 100 or less, then the employer is a small employer that is eligible for Covered California for Small Business.

What should I know about calculating full-time-equivalent employees?

• Calculating the total FTE employee count is your responsibility as an employer.

• Employers that have more than 100 FTE employees are not eligible for Covered California for Small Business.

• Not all FTE employees may be eligible for coverage with Covered California for Small Business. Employees who are eligible for coverage include:

  • Full-time employees (those who work 30 or more hours per week).

  • Part-time employees (those who work 20-29 hours per week) at the employer’s discretion.

Employees who are not eligible for coverage include those employees who work less than 20 hours per week, receive a Form 1099 or are seasonal or temporary employees.

For more details, see the Internal Revenue Service (IRS): irs.gov/affordable-care-act/employers/small-business-health-care-tax-credit-and-the-shop-marketplace

Do you have questions? Call your broker or tax professional, or contact CCSB at (844) 332-8384 or SmallBusiness@covered.ca.gov.

*Not all businesses will qualify. To verify that your small business is eligible for a federal tax credit, please consult a professional tax adviser. The credit only applies for two consecutive tax years based on premiums paid for employees.

**Federal tax credit income limits are adjusted annually as updated IRS publications for the prior tax year become available in the first quarter of the proceeding calendar year. For example, the 2020 tax income limit will not become available until early 2021. Please refer to Form 8941: Credit for Small Employer Health Insurance Premiums for the most current information.