Group health plans may deny participation based on which factor?

Group health plans may deny participation based on a member's part-time employment status because eligibility for participation in many group health plans is often tied to the employment status of the individual. Most employers provide health insurance benefits primarily to full-time employees, meaning those who work a minimum number of hours are generally eligible for coverage. Part-time employees, who typically work fewer hours than full-time employees, may not meet the plan's criteria, which can include working a specific number of hours per week or month.

Employers have the discretion to define what qualifies as full-time status for their health plans, and this can vary from one organization to another. As a result, someone who is considered part-time could be denied access to the group health plan based solely on their employment classification.

In contrast, the other factors listed do not typically serve as legitimate grounds for denying participation in a group health plan. Age is generally not a permissible factor due to anti-discrimination laws, health history can’t be used for denial in most cases due to regulations that prohibit discrimination based on pre-existing conditions, and location of the employer is less likely to be a basis for denial compared to employment status. Therefore, focusing on part-time employment status is the reason this choice is the most applicable factor for