Employer group: at least 2 employees.

Association (a)(3): at least 2 members and 25% of eligible members.

Creditor group: 10 new entrants a year; payable to the creditor.

Newspaper carriers: at least 10; no individual choice of amounts.

Small group 2–100 employees (outline); large group 101+.

Noncontributory = policyholder pays all; everyone eligible is covered.

Contributory = employees share the premium and choose to enroll.

Association members are classified one by one.

HMO: network only, gatekeeper referral for specialists.

PPO: reduced benefit out of network; usually no referral.

POS = HMO + PPO blend; EPO = no out-of-network benefit except emergencies.

Self-funded: the employer bears the claims risk; a TPA only administers.

ERISA: private plans of any size; governmental plans are excepted.

State mandates reach insured plans, not private self-funded plans.

No new self-funded MEWAs since November 30, 1995.

FSA: employee salary reduction; use-it-or-lose-it.

HRA: employer money only.

HSA: requires an HDHP; rolls over; portable.

Registered domestic partner = same coverage and terms as a spouse.

Blanket = insured by class description, not by name.

Camp or team blanket policy is not a substitute for ACA coverage.

Dependent children: coverage available to age 26.

Group underwriting looks at the group, not individuals.

Large group factors: occupation, size, prior claims.

Small group premium: only age, region, individual or family.

Small group = guaranteed issue; no steering for health reasons.

Tax credit: 25 or fewer FTEs, pay 50%+, buy through CCSB.

QSEHRA: small employer with no group plan; employer money only.

ICHRA: any size; never offered with a group plan to the same class.

COBRA: 20+ employees; 18 / 29 / 36 months; 102%.

Cal-COBRA: 2–19 employees; 36 months; 110% (150% if disabled, after 18 months).

Job loss = 18 months of COBRA; divorce or aging out = 36.

ADA and PDA: 15+ employees; COBRA: 20+; FMLA: 50+.

HIPAA: no eligibility or price rules based on health status; wellness discounts OK.

FMLA: 12 months, 1,250 hours, 50 employees within 75 miles; coverage maintained.

HIPAA special enrollment: at least 30 days to request.

ALE = average of 50+ full-time employees, including equivalents.

FTEs: part-time hours ÷ 120 each month.

Affordable: employee share of cheapest minimum value plan ≤ 9.5% (as adjusted) of household income.

Minimum value = at least 60%.