• With few exceptions, small employers cannot be turned down. This is called guaranteed issue. If you employ at least 1 but not more than 50 employees, health insurers and HMOs must sell you any small group health plan they sell to other small employers.

However, they can require that up to 75% of your eligible employees sign up for coverage if it is the only source of coverage being offered or 37.5% of your eligible employees sign up for coverage if other plan options are being offered as well.  If you are buying a large group health plan for 51 or more employees, your group can be turned down.

• Your group health plan cannot be canceled because someone in your group becomes sick. This is called guaranteed renewability and it applies to group plans of all sizes. Insurers and HMOs can impose other conditions, however. They can require you to meet minimum participation rates in order to renew your coverage. Additionally, they can refuse to renew your coverage for nonpayment of premiums or if you commit fraud, or if they are discontinuing that health plan or if they are withdrawing from the small employer market. In the case of discontinuance, they must give you a chance to buy other plans they sell to groups of your size.