Rules and requirements
Missouri small business health insurance requirements
The rules that decide whether you qualify for a small group plan, what carriers expect from you, and what you owe employees who leave.
Quick version: Missouri small groups have 2 to 50 eligible employees working 30 or more hours a week. Small employers do not have to offer coverage. Carriers generally expect the business to pay at least half of employee-only premiums and a solid share of eligible employees to enroll. Under 20 employees, Missouri continuation rules apply instead of federal COBRA.
Who counts as a small employer in Missouri
Under Section 379.930 of the Missouri statutes, a small employer is one that employed an average of at least 2 and no more than 50 eligible employees on business days during the prior calendar year, and that has at least 2 employees on the first day of the plan year. The Missouri Department of Commerce and Insurance confirmed the 2 to 50 range in its Bulletin 15-04.
- Eligible employee: works full time with a normal work week of 30 or more hours.
- Owners and partners can count when they are included as employees under the plan.
- Family members: a person, their spouse and their minor children employed by the same business count as one eligible employee.
- New businesses use the number of employees they reasonably expect to have in the current year.
Do you have to offer coverage?
Not if you are under 50. The ACA's employer shared responsibility rules apply only to applicable large employers, meaning businesses that averaged 50 or more full-time employees, including full-time equivalents, in the prior year. Full time means 30 hours a week or 130 hours a month. Missouri adds no separate mandate on top of that.
Carrier participation and contribution rules
Carriers set their own underwriting rules for small groups. The two that matter most:
Participation
Carriers want enough eligible employees to enroll that the group is not just the people who expect big medical bills. A common benchmark is 70 percent, and employees who waive because they have other coverage, such as a spouse's plan or Medicare, usually do not count against you. The federal SHOP rules also use 70 percent as the default.
Employer contribution
Most carriers expect the business to pay at least 50 percent of the employee-only premium. You can contribute more, and you can choose whether to help with dependent coverage. Contributions have to be applied consistently within a class of employees.
Waiting periods and eligibility classes
You can require new hires to wait before coverage starts, up to a federal maximum of 90 days. You can also limit eligibility to full-time employees. What you cannot do is set rules based on health status or single out individual employees.
Missouri continuation coverage for employers under 20
Federal COBRA covers employers with 20 or more employees. For smaller employers, Missouri's continuation law (Section 376.428) fills the gap. Per DCI Bulletin 09-02, it mirrors federal COBRA:
- Group health, dental and vision coverage can continue for up to 18 months after a job loss or cut in hours.
- Certain later events can extend that to 36 months.
- The carrier can charge up to 102 percent of the group rate.
- No proof of insurability is required.
Older guides sometimes cite a nine-month state continuation period. That rule was replaced in 2009.
Open enrollment and special enrollment
Employers can start a small group plan in almost any month. Once the plan is in place, employees join at hire, during your annual open enrollment, or after a qualifying life event such as marriage, a birth or losing other coverage.
Where to get official answers
The Missouri Department of Commerce and Insurance regulates insurers and agents in the state and runs a consumer hotline at 800-726-7390. For anything specific to your group, a broker can usually get you an answer faster, and that is part of what we do at no cost. Read more in our guides to small group plans and what coverage costs.
This page is general information, not legal or tax advice. Confirm details for your business with your advisor.
FAQ
Rules and requirements questions
Is a Missouri small business required to offer health insurance?
No. Neither Missouri law nor the ACA requires employers with fewer than 50 full-time employees, including full-time equivalents, to offer coverage. Many do anyway to hire and keep people. Once you reach 50, the federal employer mandate applies.
What is the minimum participation for a Missouri group plan?
Carriers set participation minimums, and a common standard is about 70 percent of eligible employees enrolling, after excluding people who waive because they have other coverage. Rules vary by carrier, and some relax them during certain enrollment windows. We check each carrier's current rule for your group.
Can I offer coverage only to some employees?
You can set reasonable eligibility rules, such as full-time status or a waiting period of up to 90 days, but the rules must apply evenly to everyone in a class. You cannot pick and choose individuals or exclude people based on health.
What happens to coverage when an employee leaves?
If you have 20 or more employees, federal COBRA applies. Under 20, Missouri's state continuation law gives departing employees and their families the right to keep group health, dental and vision coverage for up to 18 months, extendable to 36 months for certain events, at up to 102 percent of the group rate.
See what your Missouri group should be paying.
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