Eligible Participant

Within an association health plan, an eligible participant is any of the following:

• An employee of an employer currently belonging to the association
• A former employee of an association employer who became entitled to association health plan coverage during his or her prior period of employment
• Beneficiaries of an eligible participant

People who are not eligible participants are excluded from enrollment within an association health plan.

Associations normally have membership requirements that pertain to employers who want to join the association. An association may have additional requirements that apply to employers who want to join the association’s health plan. These additional requirements may concern the size of an employer, the minimum percentage of employees who enroll in the health plan, and the minimum percentage of monthly insurance premiums paid by the employer for its workers.

Eligible participants have a variety of consumer protects regarding non-discrimination. Non-discrimination rules largely relate to how health factors cannot be used to determine an applicant’s plan eligibility, renewal, or premium. For employers, the health status of employees cannot be used as a consideration for association membership and health plan participation. For a more detailed review of these protections, see our article “Nondiscrimination Requirements for Association Health Plans.”