One Man Group/Group of One Insurance


What is One Man Group Health Insurance?

A one man group (also called Group 0f One or Self-Employed Group) plan is a group insurance policy for an individual who is self-employed and does not have any employees, and wants affordable insurance coverage like any other business owner. The law requires insurance to consider a sole proprietor as a “group”, to provide them with a group insurance plan. This is supported by federal law in certain states where there is either no high risk pool or health insurers are required to offer them with other plans. Typically, those with chronic conditions sign up for a one man group, therefore it is not favored by health insurance companies.

Because the laws and insurance varies from state to state, it is important to know what the qualifications for a group of one policy are, and which states follow these laws. There are a select number of states that have guaranteed issue for groups of one. Some states that cooperate in guaranteeing coverage has special rules to regulate the process, others are required to provide a basic health plan to all self-employed individuals.


Which States Have One Man Groups?

As of 2011, the following states offer guaranteed issue plans to groups of one:

Colorado

In Colorado, insurance companies have to provide a group insurance plan to a self-employed individual as long as they apply within the 31 day open enrollment period every year. The plans offered are either standard or basic.

Connecticut

Connecticut insurers must guarantee issue a state standardized plan to sole proprietors.

Delaware

Health insurance companies in Delaware are required to guarantee issue of standardized or basic medical coverage to self employed business owners.

Florida

In Florida, health insurance companies must guarantee issue the choices of a standard health plan, a basic plan, or a federally qualified high deductible health plan to the self-employed. These options are only available to those who apply during a 31 day open enrollment period each year.

Hawaii

For the self-employed residents of Hawaii, insurers must guarantee issue small group plans to those who qualify within a 30 day open enrollment period. Health insurance companies are also required to guarantee issue small group policies to the self-employed with qualifying events for the 30 days after the qualifying event.

Maine

Health insurance companies in Maine are required to guarantee issue the choice of a small group insurance plan, or an individual health plan to self-employed individuals.

Massachusetts

Because Massachusetts is guarantee issue in every way, there are no qualifications, enrollment periods, or limitations. Everyone who needs it gets a health insurance plan, including sole proprietors.

Michigan

Blue Cross Blue Shield of Michigan is required by law to guarantee issue of their health plans to those who run their own businesses.

Mississippi

In Mississippi, health insurance companies must guarantee issue small group policies to those who are self-employed. If the individual qualifies for or is already using a health plan under an employer, they will not be guaranteed issue.

New Hampshire

Health insurers in New Hampshire are required to provide the self-employed with small group health plans, as long as they apply within one of two open enrollment periods per year.

North Carolina

Health insurance companies in North Carolina are required to guarantee issue the choice of a small group insurance plan, or an individual health plan to self-employed individuals.

Rhode Island

Health insurance companies in Rhode Island must guarantee issue small group policies to those who are self-employed. If the individual qualifies for or is already using a health plan under an employer, they will not be guaranteed issue.

Vermont

Vermont is another state that has no criteria for guaranteed issue of benefits. Health insurance companies are required to offer you a policy as a self-employed resident.

Washington

In the state of Washington, the following criteria must be proven to ensure coverage as a group of one: the individual has has been operating the business for a minimum of the past 12 months, and this business has provided at least 75% of their income (or 51% for agriculturists).

 

Also, there are two states that offer group of one policies within certain parameters, but they are not guaranteed issue across the board.  In Oklahoma, insurance companies that cooperate with the Oklahoma Employer-Employee Partnership for Insurance Coverage Program must guarantee issue health coverage to self-employed individuals who qualify. In New Mexico, a sole proprietor can only apply if they have at least one dependent for coverage to be guaranteed issue.

 

Other Options for Self-Employed Individuals

If you do not live in one of these states, it may seem like your state legislature is working against you as a sole proprietor. If you cannot afford individual insurance, there are public health plans available in every state, and the Affordable Care Act is making sure that all individuals get a health plan within their budget. To compare the insurance companies in your area, get a quote above and see what is available for individual coverage.

 

Sources:

1. Kaiser Family Foundation, “Small Group Health Insurance Market Guaranteed Issue, 2011″. http://www.statehealthfacts.org/comparemaptable.jsp?ind=350&cat=7&sub=86&yr=200&typ=5&o=a&sortc=4

2. Washington State Office of the Insurance Commissioner, “How and Why to Become a ‘Group of One’”. http://wainsurance.blogspot.com/2010/09/how-and-why-to-become-group-of-one.html