Health coverage is a top concern for employees, but what about their families? Many workers wonder whether their employer must provide health insurance for spouses and dependents. Understanding employer requirements for family health insurance is important, especially as regulations vary based on company size and the Affordable Care Act (ACA).
At Skyline Benefit, we help businesses navigate group health insurance options, ensuring they meet compliance standards while offering the best benefits for their employees. In this blog, we’ll break down whether employers must offer family health insurance, what the ACA requires, and how you can find the right coverage.
What Are the Employer Requirements for Family Health Insurance?
Under the Affordable Care Act (ACA), large employers with 50 or more full-time employees must offer their full-time workers and dependent children up to age 26 health insurance or face penalties under the Employer Mandate. However, the law does not require these employers to extend coverage to employees’ spouses.
That means:
- Employers must offer health insurance to employees to avoid ACA penalties.
- Employers are not required to offer coverage to spouses.
- If employers do offer family coverage, it must meet affordability and minimum essential coverage standards under the ACA.
Small businesses with fewer than 50 full-time employees have no federal requirement to provide health insurance at all. However, offering coverage can be a great way to attract and retain talent.
What Does the ACA Consider “Affordable” for Family Coverage?
The ACA defines affordable coverage based on the cost of an individual employee’s premium—not the entire family’s coverage. This is known as the “Family Glitch.”
- An employer-sponsored health plan is considered affordable if the cost for the employee only (not their dependents) is less than 9.02% of household income in 2025.
- However, this rule does not apply to family coverage. As a result, some dependents may be left without affordable health insurance if employer-sponsored family plans are too expensive.
In 2023, the federal government updated the ACA to close this loophole, expanding premium tax credits to help some families afford marketplace plans instead.
What Are the Benefits of Offering Family Health Insurance?
Even though it’s not legally required for most employers to offer family health insurance, many choose to do so because of the benefits, including:
- Attracting and retaining top talent – Competitive benefits packages, including family coverage, can help businesses recruit and retain skilled employees.
- Tax advantages – Employers can deduct premium contributions as a business expense, reducing taxable income.
- Boosting employee satisfaction – Workers who have access to affordable family coverage are more likely to be satisfied with their jobs.
Employers can also consider alternative health reimbursement arrangements (HRAs) like:
- ICHRA (Individual Coverage HRA) – Allows businesses to reimburse employees for individual health insurance premiums instead of providing a traditional group plan.
- QSEHRA (Qualified Small Employer HRA) – A great option for small businesses that want to contribute to employees’ health costs without offering a full group plan.
How Can Employers Offer Affordable Family Health Insurance?
If you’re an employer looking to provide affordable family health insurance, consider these strategies:
- Explore Group Health Insurance Plans – Compare HMO, PPO, and EPO plans to find a cost-effective solution.
- Consider Contribution Strategies – Employers can choose how much they contribute toward premiums, helping to balance affordability.
- Utilize HRAs – A health reimbursement arrangement (HRA) can provide tax-free funds for employees to purchase their own family health coverage.
- Work with an Independent Broker – A broker like Skyline Benefit can help you compare plans, negotiate rates, and find the best option for your business and employees.
Need Help Understanding Employer Health Insurance Requirements?
Skyline Benefit is an independent health insurance broker in Fullerton, CA that offers affordable and flexible group health insurance options. We specialize in helping individuals and businesses understand employer requirements for family health insurance. Whether you’re a business owner looking for group coverage or an employee exploring health plan options, we can guide you.
Schedule a consultation today. Call us at: (714) 888-5112