If you’ve ever tried to set up health insurance for a small team, you may have run into a wall: the insurance company said not enough of your employees signed up, or that you weren’t paying a big enough share of the premium. For a lot of small business owners, that’s where the group plan conversation ends.
Once a year, those two hurdles come down. From November 15 through December 15, small businesses can buy a fully insured group health plan even if they don’t meet the insurer’s usual participation or contribution requirements. Coverage bought in that window generally starts January 1.
Here’s how the window works, who it helps most, and what to do now so you’re ready when it opens.
The two rules that usually stop small groups
Most small group insurers set two requirements before they’ll write a policy:
- Minimum participation. A set share of your eligible employees (often around 70 to 75%, though it varies by carrier and state) must enroll. Employees who already have other coverage, such as through a spouse, are often left out of the count.
- Minimum employer contribution. The business must pay a set share of the cost, commonly 50% of the employee-only premium.
Those rules protect insurers from groups where only the people who expect big medical bills sign up. They also keep many very small businesses, family businesses and teams with lots of spouses-on-other-plans from ever getting a group plan.
What changes from November 15 to December 15
Under the Affordable Care Act’s guaranteed availability rules, insurers must accept small employers that apply for coverage. Federal regulations (45 CFR 147.104(b)(1)) let an insurer turn down a small group for falling short of its contribution or participation rules, but only if it offers an annual enrollment period from November 15 through December 15 when those rules don’t apply. In practice, that means:
- You can’t be turned down just because too few employees enrolled.
- You can’t be turned down just because your contribution is below the carrier’s usual minimum.
- Coverage chosen during the window typically takes effect January 1 of the next year.
The rest of the small group rules still apply. You still need a real business with at least one eligible employee, the plan still covers the ACA’s essential health benefits, and rates are still based on age, location and tobacco use rather than your employees’ health.
Who this window helps most
- Very small businesses where one or two declines would sink the participation percentage.
- Teams where many employees are covered elsewhere, for example through a spouse, a parent’s plan or Medicare.
- Owners on a tight budget who want to offer a plan but can’t yet pay half of everyone’s premium.
- Businesses that were declined before for participation or contribution reasons.
Not sure your business is big enough for a group plan in the first place? Start with How Many Employees Do You Need for Group Health Insurance in Florida?
What the window does not do
| Question | Answer |
|---|---|
| Does it apply to level-funded plans? | Generally no. The window is a rule for fully insured small group coverage. Level-funded plans are underwritten and have their own approval rules, so they may be available at other times of the year. See Level-Funded vs. Traditional Group Health Insurance. |
| Does it change the employer mandate? | No. Businesses with 50 or more full-time-equivalent employees still have to meet the ACA’s employer shared responsibility rules. |
| Is it the same as individual open enrollment? | No. Individual and family coverage through the Marketplace has its own open enrollment period. For 2027 coverage it runs November 1, 2026 to January 15, 2027, with December 15 as the deadline for a January 1 start on HealthCare.gov. |
| Can I start a group plan the rest of the year? | Yes, if you meet the carrier’s participation and contribution rules. The window is for groups that don’t. |
How to get ready (start now, not on December 14)
Insurers need a complete application, and paperwork takes time. A month’s head start makes the difference between a calm January 1 start and a scramble.
- List your eligible employees. Know who works enough hours to qualify, and who already has coverage elsewhere.
- Decide on a budget. Pick a contribution you can keep paying, not just one that gets you through the door. Remember that employer premium contributions are generally a deductible business expense.
- Gather your documents. Carriers typically ask for recent payroll records (a quarterly wage report or payroll register), your business registration and EIN, and an application or waiver from each eligible employee.
- Compare plans side by side. Look at networks, deductibles and drug coverage, not just the monthly cost. Many carriers let you offer more than one plan.
- Submit early. Aim to have your application in well before December 15. Carriers can set their own paperwork deadlines inside the window, and a missing payroll page can push you past it.
- Plan the first payment. Most carriers want the first month’s premium before they’ll activate the group.
Our Small Business Open Enrollment Checklist covers more year-end steps if you already have a plan in place.
Is a group plan the right move?
The window makes a group plan possible, but it isn’t always the best fit. If your team is spread out, works part-time, or would rather choose their own coverage, an HRA might work better. With a QSEHRA or an ICHRA, your business gives employees a tax-free allowance toward their own individual plans. Read ICHRA vs. QSEHRA: Which Health Reimbursement Arrangement Fits Your Small Business? for the trade-offs.
Two more situations worth a look:
- It’s just you (and maybe your spouse)? A group plan usually needs at least one employee who isn’t an owner or an owner’s spouse. See Self-Employed Health Insurance in Florida for your options.
- Have an employee turning 65? Who pays first depends on your company’s size. See Employee Turning 65? What Small Business Owners Need to Know About Medicare and Your Group Plan.
Frequently asked questions
When is the small group special enrollment period?
Every year from November 15 through December 15. Coverage bought during the window generally starts January 1.
Do I have to contribute anything toward my employees’ premiums?
During the window, an insurer can’t decline your group for contributing less than its usual minimum. Your contribution still affects how many employees can afford to enroll, so it’s worth choosing an amount that works for both sides.
What if only one of my employees wants the plan?
During the window, low participation alone isn’t a reason for an insurer to turn you down. Outside the window, it usually is.
Will the participation rules come back at renewal?
Renewal terms vary by carrier and state, so ask before you sign how the carrier treats groups that joined during the window. It’s one of the questions I go over with every business owner.
Can I use this window if I live outside Florida?
Yes. The window comes from federal rules, so it applies across the country, though state rules and carrier guidelines add their own details. I’m licensed in all 50 states and can help wherever your business is located.
Want to use this year’s window? Let’s get you ready.
I’m Chris Puccio, an independent health insurance agent based in Boca Raton, Florida, and licensed in all 50 states. I’ll show you which carriers fit your team, what your options look like at different contribution levels, and exactly what paperwork you’ll need before December 15. There’s no cost for the consultation.
Book a free consultation or call (561) 525-6965.
This article is general information, not legal or tax advice. Plan availability, eligibility rules, deadlines and terms vary by carrier and state. Dates were checked in November 2026; Marketplace open enrollment dates are subject to an ongoing court appeal, so confirm them on HealthCare.gov or your state’s exchange.
