The following questions have been received by the Idaho Department of Insurance
regarding the Idaho Health Insurance Exchange and SHOP (Idaho Exchange), the filing process, Qualified
Health Plan standards, and other related topics. The answers are intended to offer guidance on current
issues based on the DOI’s current understanding of applicable federal and state law requirements. If you
have any concerns regarding the accuracy of any of the guidance, please contact
Wes Trexler at the DOI by phone at 208-334-4315 or email. The
DOI will continue to release additional information and revise these responses as needed.
Can a spouse (or other family member) be counted as an employee in a small employer health plan?
(1/27/2016) Yes, provided that:
• The spouse or other family member meets the minimum requirements of an eligible employee at Idaho Code 41-4703(13), and
• Counting the spouse or other family member as an eligible employee, the employer meets the definition of a small employer at Idaho Code 41-4703(28).
Idaho Code 41-4703 defines an eligible employee as one who works 30 or more hours during a normal work week (unless, by agreement between the employer and the carrier, employees who work between 20 and 30 hours per week are included). The definition includes a sole proprietor, a partner of a partnership, and an independent contractor if such individuals are offered health coverage.
It is the Department’s view that the application of Idaho’s broader definition of an employee is more inclusive of Idaho employers and employees than the narrower employee definition provided by federal guidance; therefore, Idaho’s definition is not preempted. The Department concludes that if spouses or other family members qualify as employees under IRS rules, State Tax Commission provisions and Department of Labor standards, and meet the other criteria, they qualify as employees for small employer coverage.
Note that, as explained in the Carrier Frequently Asked Questions in 2015, FAQ #16, for purposes of SHOP enrollment and the Small Business Tax Credit, group size is determined using the federal full-time equivalent (FTE) method of counting employees. Under the FTE method, sole proprietors and their spouses or other family members under current interpretation are not counted as employees. Therefore, although a small employer consisting of only a business owner and spouse who is an employee or business partner are eligible to enroll in a small group plan, the group may not be able to enroll through the SHOP or qualify for the Small Business Tax Credit.
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