May an employer decline to offer health coverage to an employee the insurer is willing to insure?

[Peter Gulia]

A New Jersey small-group health insurance contracts says an employee is a full-time employee if his or her normal workweek is at least 25 hours.

The employer would prefer to make eligible only those employees that Internal Revenue Code § 4980H would require the employer, if it were a large employer, to treat as a full-time employee (generally, 30 hours per week).

May the employer consider the insurance contract as the insurer’s obligation for what the insurer must cover (if applied for), but not necessarily a constraint on the employer’s choice of whom to make eligible under the employer’s ERISA-governed health plan?

(Assume the difference between 30 and 25 hours a week would not result in less than 75% enrollment of those employees the insurance contract defines as full-time employees.)

Is there anything that binds the employer to offer health coverage to those whom the insurance contract describes as full-time employees?

[GBurns]

Remember that the insurance contract (which is stste regulated) is not the employer's health plan (which is ERISA regulated). The insurance contract is only the way that the benefits under the employer's health plan is provided. These are 2 different issues.

[Peter Gulia]

GBurns, thank you; your thinking is greatly valuable to me.