Rules, costs & savings

Participation Requirements

How many employees must enroll

Michael Furman
Reviewed by Michael Furman, COO — 24 years in insurance · MDRT Top of the Table
NovaVida Group licensed team · Updated August 2026

Carriers usually want a minimum share of eligible employees to enroll in a group plan — commonly around 70%. There’s an important exception: a yearly special window when those minimums are waived.

The 70% Rule and Its Exception

To issue a group plan, carriers generally require roughly 70% of eligible employees (those without other qualifying coverage) to participate. If you can’t hit that, most carriers waive the participation and contribution minimums during an annual open window, typically November 15 to December 15 — a useful path to get coverage started.

Fast Facts

  • Typically about 70% of eligible employees must enroll
  • Employees with other coverage can often be excluded
  • Special window (about Nov 15–Dec 15) waives the minimum
  • ICHRA and QSEHRA have no participation rules

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Frequently Asked

What if some employees already have coverage elsewhere?

Employees with other qualifying coverage — a spouse’s plan, Medicare, or Medicaid — can usually be counted out of the participation calculation, making the 70% threshold easier to meet.