A disabled beneficiary requesting the SEP based on self-employment, or a family member’s
self-employment, must have LGHP coverage. For the coverage to be an LGHP, the company
or entity that the self-employed person owns must have 100 or more employees (in addition
to the self-employed individual) and be available to employees.
The self-employed beneficiary and employees may also have a GHP that includes multiple
employers. We will consider this multi-employer GHP an LGHP, if at least one of the
employers has 100 or more employees. If one of the companies in the multi-employer
GHP has 100 or more employees, all the GHP enrollees have LGHP coverage, even if employer
has less than 100 employees.
NOTES:
-
•
The law does not require enrollment of 100 or more individuals in the GHP plan. The
law only requires that the employer with the GHP plan meets the 100-employee requirement.
-
•
A disabled beneficiary may be either the self-employed person (e.g., currently in
an extended period of eligibility) or the “family member” of a self-employed individual
and covered under the LGHP (if the family members of employees are offered the opportunity
for such coverage).
Example of LGHP coverage for a disabled spouse of a self-employed
individual
Mr. Smith is self-employed, currently working, and has 25 employees. The company offers
GHP coverage through a multi-employer GHP. One of the businesses in the multi-employer
GHP has 150 employees.
Mr. Smith’s spouse has Medicare based on disability. Because the multi-employer GHP
includes a company with at least 100 employees, Mr. Smith’s spouse has LGHP coverage.