Employer group

Group of employees who are eligible for health care benefits extended through a benefits plan provider. A contract is drawn up and an employee-employer relationship must exist. Groups that would not qualify include social clubs and independent contractors.

employer group health plan (EGHP)

1. Group health plan paid for by the employer of 20 or more employees for medical benefits. It may be a federal employee health benefits program, employee pay all plan, multi-employer group health plan with at least one employer with 20 or more employees, or any plan in which the beneficiary is enrolled because of their employment or his or her spouse’s employment. 2. Under Medicare Secondary Payer guidelines, any health plan that is offered or contributed to by an employer, and that provides medical care, directly or through other methods such as insurance or reimbursement, to current or former employees and/or their families. It includes the federal employees’ health benefits program but not TRICARE. 3. Private group health plan paid for by the employer that covers an individual who is age 65 or older and has Medicare as the secondary payer.

Employer mandate

In insurance, some states have laws that require employers to pay part of their employees’ health insurance plan or provide a standard benefits package of insurance to all employees and their dependents. Prior to 1995, employer mandate related to federally qualified health maintenance organizations (HMOs) and an employer was required to offer at least one HMO plan to their employees.