New Jersey Small Business Health Insurance
How group coverage works for NJ employers with 1 to 50 employees: what it takes to qualify, why renewals rise, and what your options are beyond a standard plan.
An independent guide for New Jersey employers. Sources: NJ Department of Banking and Insurance, U.S. Department of Labor, IRS. Last reviewed September 2026.
A renewal increase in New Jersey isn't a verdict on your employees' health
If your group’s renewal just came in higher, it’s natural to assume a few big claims caused it. For a standard fully insured small group plan in New Jersey, that’s not how the price is set. Carriers in the state’s small employer market use modified community rating: they can price on the age of each covered person and the business’s location, and nothing else. Your group’s own claims history, health status, and industry are off the table.
That changes what actually lowers the bill. Waiting for a “better year” won’t help, because a healthy year doesn’t earn a discount either. The levers are the plan design you choose, the carrier you choose it from, how much you contribute, and whether a different funding approach, one that does price on your group’s experience, fits your business.
Worked example. A 12-person architecture firm in Morristown renews at a higher rate. Every adult on the plan is a year older, which moves each of their age-based rates up, and the carrier’s community rate changed. Switching to the same plan design at another carrier, raising the deductible, or moving to a level-funded plan are all real options. Arguing that the team had a healthy year is not.
Source: NJ Small Employer Health Benefits Program Buyer’s Guide, “Rates” and “Questions on Rates and Plans.”
Three carriers write nearly every small group policy in the state
New Jersey’s state-regulated small group market is more concentrated than most employers realize. In the first quarter of 2026, the Department of Banking and Insurance’s enrollment report shows three carriers holding essentially all of it.
| Carrier (as listed by DOBI) | Share of small group policies, Q1 2026 | Covered lives |
|---|---|---|
| Horizon Healthcare Services | 70.2% | 99,127 |
| Oxford Health Insurance (UnitedHealthcare) | 19.5% | 40,082 |
| AmeriHealth | 10.2% | 17,301 |
| Total | 28,772 policies | 156,510 |
The same reports show the market shrinking. In the second quarter of 2022 there were about 47,300 small group policies covering about 286,000 people. By the first quarter of 2026 that was down to about 28,800 policies and 157,000 people, roughly 45 percent fewer covered lives in under four years.
The report doesn’t say where those groups went. Some businesses stopped offering coverage. Others moved to arrangements that sit outside the state’s small employer market and don’t appear in these numbers: level-funded plans, professional employer organizations, and individual coverage HRAs. Those are the “alternatives to Horizon” most employers are actually asking about.
Source: DOBI SEH Quarterly Enrollment Reports, Q1 2026 plans by carrier and Q2 2022 total plans. AmeriHealth figure combines AmeriHealth Insurance Co and AmeriHealth HMO.
Qualifying takes three numbers: 1 to 50 employees, 75 percent, and 10 percent
New Jersey doesn’t require any employer to offer health coverage. If you choose to, a standard small group plan comes with three thresholds.
1 to 50 employees
Your business averaged at least one and no more than 50 employees in the prior calendar year. Owners, their spouses, partners, 2% S-corp shareholders, independent contractors, and leased employees don't count as employees. A business run by a married couple with no other staff doesn't qualify.
75% participation
At least 75 percent of employees working 25 or more hours a week must be covered by your plan or by certain other coverage, like a spouse's group plan, Medicare, NJ FamilyCare, or Tricare. A plan bought individually, including through Get Covered New Jersey, doesn't count.
10% contribution
You pay at least 10 percent of the total premium for the group. A carrier can't require more than that as a condition of issuing the plan, though most employers choose to contribute more.
The detail that trips people up: participation is measured against all your 25-hour employees, not just the ones you offer coverage to. If you have 30 such employees and offer coverage only to the 15 who work 35 hours, you still need 23 people covered.
Sources: SEH Buyer’s Guide, “Eligibility” and “Participation and Contribution Requirements”; N.J.A.C. 11:21-7.5 (participation) and N.J.A.C. 11:21-7.6 (contribution).
Step-by-step for first-time groups: How to offer health insurance to employees in NJ
November 15 to December 15 is the one window that waives both rules
A business that qualifies as a small employer can apply for coverage any month of the year, as long as it meets the participation and contribution requirements. If it can’t, New Jersey’s employer open enrollment period from November 15 through December 15 waives both. Coverage bought in that window takes effect January 1.
This is not the same as open enrollment on Get Covered New Jersey, which is the individual market and runs on a different schedule. Plenty of websites mix the two up. The employer window is shorter and it’s the one that matters for a group plan.
Source: SEH Buyer’s Guide, “Employer Open Enrollment Period.”
A standard fully insured plan is one of four ways to cover employees
Most New Jersey small businesses end up choosing among these. Each has a different relationship to the state’s small employer rules.
Standard fully insured plans
Sold by carriers in the state’s small employer market. Guaranteed issue, guaranteed renewable, and priced on age and location only. Plans are built on standard policy forms the state sets, so comparing carriers mostly comes down to networks, prescription formularies, and price.
Level-funded plans
our group pays a fixed monthly amount that funds claims, administration, and stop-loss coverage, with a possible refund if claims come in low. Unlike standard plans, pricing can reflect your group’s health, which helps some groups and hurts others. New Jersey sets minimum stop-loss thresholds for small employers.
ICHRA and QSEHRA
Instead of buying a group plan, you reimburse employees tax-free for individual coverage they choose themselves. The 75 percent participation rule doesn’t apply, which is why these appeal to groups that can’t meet it.
A PEO
A professional employer organization becomes the co-employer of your staff and puts them on its own health plan alongside payroll and HR. In New Jersey, leased employees can’t be on a small employer plan, so this is a genuinely different product.
A broker doesn't change the price of a standard plan, which is exactly why the good ones are worth it
Because standard small group rates are filed and set by age and location, the premium for a given carrier and plan is the same whether you buy it through one broker, another broker, or the carrier directly. The broker’s commission is already built into that premium, and New Jersey law requires a broker who sells you health insurance to tell you in writing what they’ll be paid.
So what you’re really choosing is judgment and service: someone who can quote across carriers and funding types, handle the paperwork and annual employer certification, and pick up the phone when an employee’s claim goes sideways.
Already have one and want to switch? How a broker of record letter works
Talk to a licensed New Jersey benefits broker
Share a few details about your business and a licensed New Jersey benefits broker will follow up. It takes about a minute. Please don’t include any health information about employees.
This site is an independent information resource, not an insurance agency. Your inquiry is shared with a licensed New Jersey insurance producer.
Frequently asked questions
We're a husband-and-wife business with no other staff. Can we buy a small group plan?
No. Under New Jersey’s small employer rules, owners and their spouses aren’t counted as employees, so a business with only the two of you has no employees to cover. Once you have at least one employee working 30 or more hours a week who enrolls in the plan, the business can qualify and both owners can be covered too.
Some of our employees already have coverage through a spouse. Do they hurt our participation rate?
No. Employees covered under a spouse’s group plan, another group plan, Medicare, Medicaid or NJ FamilyCare, or Tricare count toward the 75 percent requirement. Employees who bought an individual plan on their own do not count.
Can our carrier cancel us because one employee had very large claims?
No. Standard small group plans in New Jersey are guaranteed renewable, and a carrier can’t drop a group or an individual member because of claims or health status. Non-renewal is limited to reasons like unpaid premium, fraud, failing to return the annual employer certification, or no longer meeting the small employer, participation, or contribution rules.
Do we have to offer health insurance to employees in New Jersey?
New Jersey doesn’t require any employer to offer coverage. The federal employer shared responsibility rules apply to applicable large employers, generally those with 50 or more full-time and full-time-equivalent employees. Businesses under that size decide for themsel
Is there a deadline to set up a plan for next year?
Not if you meet the 75 percent participation and 10 percent contribution rules, since you can apply any time. If you can’t meet one of them, apply between November 15 and December 15 for a January 1 start.
