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Valid waiver reasons

Health insurance carriers require a minimum percentage of all eligible employees to enroll in the employer-sponsored health benefit plan. If an employee chooses to decline coverage for a valid waiver reason, then he or she is excluded from the total employee count and is not counted against the participation requirement.

Examples of valid waiver reasons accepted by most carriers include:

  • Other group coverage through a different employer
  • Other group coverage through a spouse or parent
  • Enrolling as a dependent in your employer's group health plan
  • Coverage through Medicare
  • Coverage through Medi-Cal
  • Coverage through Tricare

Note: Having individual health insurance is not considered a valid waiver by most carriers.

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