Who Is Eligible

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.

• 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.