Florida does not require employers to offer group health insurance to their workers, no matter how large or small the business. The requirement comes from federal law instead: if your company averages 50 or more full-time equivalent employees, the Affordable Care Act forces you to offer qualifying coverage or pay a penalty. That means Florida group health insurance requirements for employers are really a stack of three things working together—a federal mandate that may or may not apply to you, Florida benefit rules that attach to any plan issued in the state, and continuation-of-coverage obligations when someone leaves the job.
Who Actually Has to Offer Coverage
The threshold that matters is the federal “Applicable Large Employer,” or ALE, test. You are an ALE if your workforce averaged at least 50 full-time equivalent employees during the prior calendar year.1Internal Revenue Service. Determining if an Employer is an Applicable Large Employer A full-time employee is anyone averaging at least 30 hours per week or 130 hours in a calendar month. Part-time workers count fractionally: add up all their monthly hours, capping each person at 120, then divide by 120. The result, added to your full-time headcount, tells you whether you crossed the line.
Below that threshold, offering coverage is voluntary. Florida insurance law separately defines a “small employer” as a business with 1 to 50 employees whose principal place of business is in the state, and small-employer plans are subject to specific rating rules and must cover Essential Health Benefits.2Online Sunshine. Florida Code 627.6699 – Employee Health Care Access Act Nothing in state law, though, obligates a small employer to put a plan in place.
What a Qualifying ACA Plan Must Look Like
If you are an ALE, the coverage you offer has to clear three bars. First, you must offer Minimum Essential Coverage to at least 95% of your full-time employees and their dependents, with “dependents” meaning children up to age 26 and not spouses.3Internal Revenue Service. Employer Shared Responsibility Provisions Second, the plan must provide Minimum Value, meaning it pays at least 60% of the total expected cost of covered benefits.4Internal Revenue Service. Minimum Value and Affordability Third, it must be affordable. For 2026 plan years, coverage is affordable when the employee’s share of the self-only premium does not exceed 9.96% of their household income.
Because you rarely know an employee’s household income, the IRS gives you three safe harbors for the affordability test. The W-2 safe harbor uses the employee’s Box 1 wages. The rate-of-pay safe harbor uses 130 hours multiplied by the employee’s hourly rate, or the monthly salary for salaried workers. The federal poverty line safe harbor caps the monthly employee cost at $129.89 for 2026 in the 48 contiguous states. Meeting any one of them satisfies affordability for that employee.
Penalties for Getting It Wrong
Two separate penalties exist. The first applies when an ALE fails to offer coverage to at least 95% of its full-time employees and even one of those employees receives a premium tax credit through the Marketplace. For 2026 the penalty is $3,340 per full-time employee for the full year, minus the first 30 employees.5Internal Revenue Service. Rev. Proc. 2025-26 A company with 80 full-time employees would owe $3,340 times 50, or $167,000.
The second penalty applies when you do offer coverage to enough employees, but it fails the minimum value or affordability tests and at least one full-time employee receives a Marketplace subsidy. That penalty is $5,010 for 2026, assessed only on each employee who actually received a subsidy rather than on the whole workforce, and the total is capped at what the first penalty would have been.6Internal Revenue Service. Questions and Answers on Employer Shared Responsibility Provisions Under the Affordable Care Act
Florida Benefit Mandates That Apply to Any Plan
Once you decide to offer coverage, Florida law dictates certain things the plan has to include. These apply whether you are a small employer offering coverage voluntarily or a large employer meeting your ACA obligations.
Autism Spectrum Disorder Coverage
Group health plans in Florida must cover screening for autism spectrum disorder in well-baby and well-child visits, along with treatment through speech therapy, occupational therapy, physical therapy, and applied behavior analysis.7Florida Senate. Florida Code 627.6686 – Coverage for Individuals with Autism Spectrum Disorder Required The statute sets an annual benefit cap of $36,000 and a lifetime cap of $200,000, both adjusted each January for medical inflation. Deductibles and coinsurance for autism treatment cannot be worse than what the plan applies to physical illnesses generally.
Substance Abuse Treatment
Florida requires insurers to offer substance abuse treatment benefits to group policyholders during the application process. The employer can accept or decline. If included, the benefits must provide at least $2,000 in lifetime benefits, up to 44 outpatient visits, and coverage for intensive treatment programs.8Florida Senate. Florida Code 627.669 – Optional Coverage Required for Substance Abuse Impaired Persons
Essential Health Benefits for Small Groups
Non-grandfathered plans in the small group market (1 to 50 employees) must cover all ten categories of Essential Health Benefits, from hospitalization and prescription drugs to mental health services and pediatric dental and vision care.9Centers for Medicare & Medicaid Services. Information on Essential Health Benefits (EHB) Benchmark Plans The specific scope of each category comes from Florida’s benchmark plan, the Blue Cross and Blue Shield of Florida BlueOptions PPO. Large group plans are not required to follow the benchmark, though most cover comparable benefits.
Continuation of Coverage When Employees Leave
When someone loses group coverage, one of two laws requires you to let them keep it temporarily. Which one depends on your headcount.
Federal COBRA at 20 or More Employees
If your company had at least 20 employees on more than half of its typical business days the prior year, federal COBRA applies. Full-time and part-time workers both count toward the 20, with part-timers prorated by hours.10U.S. Department of Labor. FAQs on COBRA Continuation Health Coverage for Employers and Advisers
COBRA allows a former employee and covered dependents to continue the same group health plan for up to 18 months after a qualifying event like termination or a reduction in hours. Dependents facing a second qualifying event, such as divorce or the former employee’s death, can extend coverage up to 36 months total.11Centers for Medicare & Medicaid Services. COBRA Continuation Coverage A person who is disabled at the time of the qualifying event may qualify for 29 months. You can charge up to 102% of the full group premium. Qualified beneficiaries have at least 60 days from the date they receive the election notice to decide whether to enroll.
Florida Mini-COBRA Under 20 Employees
Employers too small for federal COBRA fall under the Florida Health Insurance Coverage Continuation Act, often called mini-COBRA. It fills the gap for businesses with fewer than 20 employees that maintain a group health plan.12Florida Senate. Florida Code 627.6692 – Florida Health Insurance Coverage Continuation Act The coverage period mirrors federal COBRA at 18 months, with a possible extension to 29 months for someone disabled at the time of the qualifying event. The premium is capped at 115% of the group rate during the standard period and 150% during the disability extension. The former employee or dependent must notify the insurer in writing within 63 days of the qualifying event; after the insurer sends an election notice, the person has 30 days to elect coverage and pay the initial premium.
Conversion to an Individual Policy
Regardless of your size, Florida law gives departing employees the right to convert their group coverage to an individual policy issued by the same insurer. The employee must have been continuously covered under the group plan for at least three months and must apply within 63 days of losing group coverage.13Florida Senate. Florida Code 627.6675 – Conversion on Termination of Eligibility The converted policy will follow the insurer’s individual rates and coverage rules rather than mirror the group plan, but the insurer cannot deny the application based on health status. Conversion is an additional option alongside COBRA or mini-COBRA, not a replacement.
Ongoing Administration Once a Plan Is in Place
Special Enrollment Periods
Federal law requires you to let employees enroll outside the annual open enrollment window when they experience certain life events. Marriage, the birth or adoption of a child, and loss of other health coverage each trigger a 30-day special enrollment period. Employees who lose eligibility for Medicaid or a state Children’s Health Insurance Program, or who become newly eligible for premium assistance through those programs, get 60 days to enroll.14U.S. Department of Labor. FAQs on HIPAA Portability and Nondiscrimination Requirements for Workers Missing a special enrollment request can expose you to a benefits claim if an employee gets denied coverage they were legally entitled to join.
Required Employee Disclosures
You must provide employees with a Summary Plan Description within 90 days of first becoming covered. The document explains the plan’s benefits, exclusions, and how to file a claim in plain language. Separately, you must distribute a Summary of Benefits and Coverage, a standardized four-page document, at specific points: with initial enrollment materials, at open enrollment each year, upon renewal, and within seven business days of an employee’s request. Any material change to the plan requires distributing an updated summary at least 60 days before the change takes effect.
Annual IRS Reporting for ALEs
Every ALE must file two forms with the IRS each year. Form 1094-C is the transmittal that summarizes your company’s coverage offers, and Form 1095-C details the coverage offered to each full-time employee month by month.15Internal Revenue Service. Questions and Answers About Information Reporting by Employers on Form 1094-C and Form 1095-C For the 2025 calendar year, Forms 1095-C were due to employees by March 2, 2026, and to the IRS by March 31, 2026. Expect similar timing for the 2026 calendar year with deadlines in early 2027. Electronic filing is required for ALEs filing 10 or more returns.
PCORI Fees for Self-Insured Plans
If you sponsor a self-insured group health plan rather than buying a fully insured policy from a carrier, you owe an annual fee to fund the Patient-Centered Outcomes Research Institute. For plan years ending between October 2025 and September 2026, the fee is $3.84 per covered life. It is reported on IRS Form 720 and due by July 31 of the year following the plan year’s close. Fully insured plans avoid this fee because the insurer pays it.