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Other Information for Businesses
New Guide: Health Reimbursement Arrangements (HRAs)
Compare your options for offering HRAs or group coverage.
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Health insurance for businesses.
- Deciding between group coverage & an HRA?
- Individual coverage Health Reimbursement Arrangements (HRAs)
- Health Reimbursement Arrangements (HRAs) for small employers
- Health coverage for self-employed
- How the Affordable Care Act affects small businesses
Offering health coverage is a major decision for your business. When looking for a plan that fits the needs of your business and employees, you should carefully consider things like the cost to you and your employees, and the health services covered.
For a basic guide on some health insurance products and services that may be available to small businesses, check out these resources. You can also contact a licensed agent or broker for more help.
Note: Business owners with no employees can use the Marketplace for individuals and families to enroll in a health plan that best fits their needs. Learn more about coverage options for self-employed individuals here.
Group health insurance coverage
A group health insurance plan, like a plan purchased through the Small Business Health Options Program (SHOP) or otherwise from a private insurance company, provides coverage to eligible employees. Business owners can offer their employees one plan or a selection of plans to choose from.
Small employers (generally those with 1-50 employees) may be eligible to purchase coverage through SHOP .
Enrolling in a SHOP plan is generally the only way for an eligible small employer, including non-profits, to claim the Small Business Health Care Tax Credit .
- Learn more about purchasing insurance through SHOP
- See SHOP plans and prices
- How the Affordable Care Act (ACA) affects small businesses
If there are no SHOP plans available in your area, or your business is a large employer, you can work with an insurance company or licensed agent or broker to find out what group plans may be available to you, or learn more using the resources below.
Health reimbursement arrangements
Health reimbursement arrangements (HRAs) are a type of group health plan. HRAs allow employers to help their employees pay for medical expenses, including premiums for individual coverage in some cases.
Guide to health reimbursement arrangements
Different types of health reimbursement arrangements may be available, depending on the size of your business and type of arrangement you offer, including HRAs for:
- Qualified small employers
- Individual coverage, such as Marketplace plans
- Additional health benefits (when offered with a traditional group plan)
Use this guide to help you learn the key differences and decide on your options.
Health Savings Accounts and other tax-favored health plans
There are various health plans that are designed to give individuals tax advantages to offset health care costs. These include: Health Savings Accounts (HSAs) , Health Flexible Spending Arrangements (FSAs) , and Health Reimbursement Arrangements (HRAs) .
For more details on tax-favored health plans, refer to IRS Publication 969.
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Small Business Health Insurance
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Small Business Insurance Made Easy with eHealth
Shopping for health insurance plans for your small business couldn't be more simple. eHealth has a curated selection of affordable group health insurance plans from trusted carriers. Our licensed agents can provide personalized recommendations and walk you through the application and enrollment process with no pressure or expectations to enroll.
We’re your advocate
If you ever need help dealing with the health insurance company regarding claims, billing or need any assistance, we’ll be there for you.
We have the best prices
Prices are fixed by law. We will have the best prices on any health plan we sell.
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We will empower you with decision making tools so that you decide what health plan is best for you.
1,300 small business health insurance plans from over 70 carriers - See insurance company info
Monthly cost starts at:
Pricing varies based on specific circumstances. Prices shown are estimated minimum rates for two 30-year-old employees with an employer contribution rate of 50% (the minimum in most states).
Can eHealth help with health reimbursement arrangements?
Yes! eHealth can guide you through the process of setting up a Individual Contribution Health Reimbursement Arrangement, also known as ICHRA . These flexible cost options offer many advantages over traditional group plans:
- Remote employees can pick plans in their area, even if it's a different location than their employer.
- There are no minimum participation requirements. Employees can waive coverage if they wish.
- Employees can enroll outside of the federal open enrollment period.
- All employees can participate, even part-time and seasonal workers.
- Gives employers freedom to control costs and there are no limits to how much an employer can reimburse.
- More options means employees can choose plans and doctors that work for them.
- Employees can keep them if they change jobs, the only change would be the employer reimbursement.
To learn more about your options, call 1-877-456-6670 , or click here to get a quote.
Small Business Health Insurance Basics
How does it work?
How does small business health insurance work?
Getting coverage through a small business health insurance plan can be more affordable than buying coverage by yourself. Here's what you need to know:
- Coverage is generally guaranteed issue.
- You need at least one employee to qualify.
- You must contribute toward employee premiums.
- And you can shop for coverage at any time of the year.
How much does small business health insurance cost?
An average eHealth small business plan covers 5 people and costs $1432 per month in premiums - or $286 per person.
Does my business qualify for a health insurance tax credit?
You may qualify for a tax credit that could cover some of the costs you pay for employees' premiums. This credit reimburses qualifying small businesses for up to 50% of the premiums paid toward health, dental, and vision insurance. eHealth can help you obtain your tax credit and find a small business health insurance plan that works best for you and your employees. In order to qualify:
- The average annual wage per worker must be less than $50,000.
- Your business needs to have 25 full-time employees or less.
- You need to contribute a minimum of 50% toward employee health coverage.
How to choose the right small business health insurance plan
Assess your needs.
First, determine what your small business needs in a health insurance plan. Consider the following:
- Who will be covered? Consider the needs of your employees and their dependents to find a plan that will suit the diverse medical and financial needs of the group.
- How much cost sharing can you afford? Premiums for small business health insurance are paid by the employees and the employer. Make sure consider how much cost sharing makes sense for your business.
- What kinds of benefits are important for you and your employees? While federal privacy laws prohibit employers from inquiring about employees medical history, it’s important to ask your employees which types of benefits are important to them.
Compare small business health insurance options
There are a lot of factors to consider when weighing your small business health insurance options. At eHealth, we recommend using the following 5 criteria to find plans that best match your needs:
- Monthly premiums : Know what you and your employees will be able to pay on a monthly basis.
- Deductibles, copayments and coinsurance : Ensure these types of payments will be manageable for you and your employees when you receive medical care.
- Medical provider networks : If you already have a preferred doctor or facility, make sure they'll be included in your new coverage.
- Prescription drug coverage : Use eHealth prescription drug comparison tool to see which plans cover costs of certain prescriptions.
- Coverage add-ons : With eHealth, you can add things like vision and dental care to ensure your employees are fully covered.
Small business health insurance enrollment process
- Enrollment is the process of getting your employees and their dependents signed up for your new health plan. Once you've selected a plan, an eHealth agent can walk you through the enrollment process.
- During enrollment, be sure to answer all questions honestly and to the best of your knowledge. Though premiums may differ based on medical history of certain individuals, no employee will be declined coverage.
Compare Types of Small Business Health Insurance Plans
Learn about different types of health insurance coverage options to find the plan that’s best for you and your employees. Common types of health insurance plans include:
- Each member selects an in-network Primary Care Physician (PCP)
- Referrals from your PCP are often required to see a specialist
- Out-of-pocket costs are predictable and often limited to low annual deductibles and copayments for doctor visits and other covered services
- The number of providers in the HMO network varies by location
- Members don’t have to choose a PCP
- Members don’t need a referral to see a Specialist
- Members can choose any doctor or hospital regardless of whether the provider is in the plan’s network (costs may increase for out-of-network care)
- Out-of-pocket costs may include annual deductibles, copayments, and coinsurance for covered services
- Members usually need to select an in-network PCP
- Members usually don’t need a referral to a Specialist to receive POS plan benefits
- Members can choose to use the plan’s provider network for some services and go outside the network for other services
- Members usually pay a small portion of the cost of covered services when they stay in the POS network
What people are saying
eHealth makes it easy for small business owners to find the perfect plan at the lowest available cost
“Before working with eHealth I thought buying group health insurance would be difficult. I didn't expect it to be as EASY as eHealth made it. My advice, work with eHealth - it's easy.”
- MS Glass LLC , Texas
“As a busy business owner, I needed eHealth to advise me and handle my group health insurance details. eHealth is an invaluable resource. Health insurance doesn't have to be complicated. Need help? call eHealth!”
- Tabatha , Nevada
“eHealth gave me confidence that we found the most affordable health plan for our business. Call eHealth, they make it simple.”
- Cristy , Smash Marketing in Colorado
“Choosing the right health plan can be complex. eHealth helped me understand the pros/cons to each plan choice. eHealth made group health insurance EASY!”
- Paul , New Jersey
“At first I felt buying group health insurance was so confusing. But eHealth made it so much simpler. eHealth makes health insurance easy!”
- Brett , Georgia
“eHealth gave me the guidance to feel confident buying group health insurance. Don't wait, ask eHealth about Small Business health insurance.”
- Carlos , Texas
“eHealth's customer service makes group health insurance easy. At renewal time, eHealth answered all my questions and showed me all the options they offer.”
- Cindy , Texas
“eHealth gave me the support I needed to pick the right plan and complete the application. My advice, stop researching and go to eHealth for help!”
- Arthur UX , California
“I was unsure about choosing the right health plan for my business. eHealth explained all my options, honestly. eHealth gave me the assurance I needed to find the right health plan.”
- Any Screen Inc. , Colorado
“eHealth guided me to the best options in health insurance for my business. I felt very comfortable with the process and the results. I would advise friends to sign up through eHealth.”
- Elliott S. , California
“I'm advising my friends to use eHealth! The process of signing up or a group plan was simple.”
- Sarika K. , Texas
“The process of signing up for a group plan was fast and easy with eHealth. They made health insurance accessible. SIGN UP THROUGH EHEALTH!”
- Ekaterina S. , Florida
eHealth has a fabulous and effective on-boarding process.
A great agent partner makes a huge difference!
- Russell W. , Texas
“It is a breath of fresh air to work with eHealth, where the team takes customer service to the next level.”
- Varner Faddis Elite Legal , Colorado
“It's hard to even explain how much eHealth helped us. By having a conversation about my specific health insurance needs, we were able to save over $600 a month.”
- Rachel M. , Virginia
Frequently asked questions
The insurance company will determine the final monthly cost for your group health insurance plan once your application has been reviewed and approved. Costs vary based on a number of criteria, including the size and location of your company, and the ages of your employees. As part of the Affordable Care Act, the health of your employees, including pre-existing conditions, no longer impact group health insurance rates. Please note that your final monthly rate will be the same whether you apply through eHealth, another health insurance agent, or directly with the insurance company.
An average eHealth small business plan covers 5 people and costs $1,432 per month in premiums - or $286 per person.
Typically, an employer covers at least 50% of the employee's monthly premium. In these cases, the employee covers the remainder of their own premium and then covers the full premium for any of their dependents. Minimum employer contribution levels may differ from state to state and from one insurance company to the next. Also, some employers opt to cover a higher percentage of the employee's monthly premium and sometimes a portion of the premium costs for an employee's dependents.
During the application process, you'll be able to indicate how much of your employees' (and their dependents') monthly premiums you would like to cover.
Group health insurance plans don't include coverage for dental and vision, but these are often available as benefit riders that can be added to your group health insurance plan for additional fees. Once you select a group health insurance plan, you'll have the opportunity to view the additional insurance plans or riders that are available in your area.
If you already have a broker or have purchased a group health insurance plan in the past through a broker or health insurance company, eHealth can help you to maintain your current plan or find a new plan that meets your health insurance needs.
In addition:
- eHealth provides you with world-class customer service.
- eHealth is a platinum agent with many top health insurance companies.
- eHealth has dedicated account managers to assist you.
- Rates are regulated and do not vary by broker, so there's no additional cost to you.
eHealth offers over 1,300 group health insurance plans from 70+ carriers throughout the United States. Our licensed agents shop and compare products from multiple insurers to curate plans that are optimal for each company's specific needs.
Group health insurance plans are categorized as either indemnity plans (also known as "traditional indemnity," "fee-for-service," or "FFS" plans) or managed care plans. Indemnity and managed care plans differ in their basic approach. The major differences concern choice of providers, out-of-pocket costs for covered services, and how bills are paid:
With an indemnity plan, you typically have a broader choice of doctors (including specialists, such as cardiologists and surgeons), hospitals, and other health care providers.
With a managed care plan, you typically have less out-of-pocket costs and paperwork. Indemnity plans once dominated the American health insurance market, but are no longer as popular as they used to be. Managed care plans now take up a much larger share of the general health insurance market and are especially dominant in the western parts of the country. There are three basic types of managed care plans: PPOs, HMOs, and POS plans.
An ICHRA plan can enable a company to focus on their business rather than navigating the complexities of group health plans. Monthly reimbursements provided by the employers don’t count as taxable income. In most cases, ICHRA increases employee options for health coverage by allowing them to shop for plans in the individual market and select coverage that best suits them.
Here are the steps for selecting and applying for a group health insurance plan:
- Tell us about your company and employees on eHealthInsurance.com.
- We provide you with health insurance quotes for leading companies in your area.
- You then compare plan rates and benefits to find the plan that best meets your needs.
- You'll be able to speak with a licensed agent for personal help selecting a plan and starting the application process.
Businesses with fewer than 50 full-time-equivalent employees aren't required to provide health insurance to their employees and won't face tax penalties for not doing so.
But that doesn't mean small businesses should not, or will not, provide health insurance for employees. Many wise employers offer health insurance because it's better for their workforce. Health benefits allow them to recruit and retain talented employees who expect to get health insurance with a job. And, when employees have access to health care, they're more likely to take part in preventative care procedures, which reduces illnesses, reduces absenteeism, and increases productivity.
In addition, small business employers may receive tax credits when they provide coverage, as follows:
- Employers with 25 or fewer full-time equivalent employees with average annual wages of less than $50,000, may be eligible for a special tax credit of up to 50% of the amount the employer contributes (at least 50%)toward employee insurance premiums.
Whether you offer health insurance to employees or not, you should make your employees aware of their obligation to seek health coverage under the Affordable Care Act. You also have to let your employees know that they have access to guaranteed coverage in the individual market and that they may be eligible for government subsidies if the coverage you provide them is not deemed to be affordable under the law.
Find your small business health insurance plan
Provide some information about your small business and get free quotes on group coverage
Shop Group Insurance Plans by State
Learn more about small business health insurance options availble in your state
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Not sure where to start? Try our Buyer’s Guide for Small Business Owners
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Get health insurance for your small business
Health insurance is a critical factor for small businesses to help retain and recruit employees and sustain productivity and satisfaction. UnitedHealthcare offers a range of group health insurance options designed to help your small business save money and support your employees’ health and well-being.
Request a quote for your small business (2-50 employees)
Simply complete a quick form to get started with a quote for your small business. A UnitedHealthcare representative will get in touch and work with you to help find group health insurance options that best fit your business.
View plans or request a quote (2-50 employees)
To get more details on health insurance options for your small business, click on your state below. In markets where the Small Business Store is available, 1 you will be directed there. In markets where the Small Business Store is not available, you can request a quote from UnitedHealthcare.
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- District of Columbia
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For companies with 51 or more employees
Find the right medical plans for your employees and your business, plus supplemental plans for dental, vision, disability and more.
Explore products and solutions for small businesses
There's not just one way we work to help small businesses like yours. By offering benefits packages designed to improve employee experience and help employers manage cost, there's a number of products and solutions that may be right for your business.
Explore a range of group health plans and network options.
Discover how integrated pharmacy benefits from OptumRx may help lower costs for you and your employees.
Enhance your employees’ specialty benefits package with vision, dental, financial protection plans and more.
See how we are guiding employees to the behavioral care they need.
Get more health plan resources
Find information to help you and your employees get the most from their health benefits.
Did you know?
UnitedHealthcare’s employer-sponsored insurance plans serve groups that fall into three categories: Small Group plans refer to employers with up to 100 employees; Key Accounts is for employers with 101 to 5,000 employees; and National Accounts serves employers with more than 5,000 employees.
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Self-funded plan designs from Allstate Benefits are a great choice for small and mid-sized employers who are looking for ways to take control of their health care costs. Employers may even receive a refund in years when claims are lower than planned.
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Secure Choice fully insured plans from Allstate Benefits are a great option for small businesses that are looking for a traditional major medical plan. Administrative services, such as claims processing and customer service, are taken care of, leaving employers free to focus on their business.
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Best Health Insurance Companies for Small Businesses
Blue Cross Blue Shield shines for availability and its wellness programs
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When it comes to health insurance coverage, a small business is generally considered an employer with one to 50 employees, excluding the owner, their spouse, and any family members. However, some states and private companies include businesses with one to 100 employees in their definition of a small business. You can use the Small Business Health Insurance Options Program (SHOP) to find ACA-compliant group plans, which you can offer to employees by purchasing coverage with help from an agent or broker. A SHOP plan is the only way to qualify for the Small Business Health Care Tax Credit if you meet the eligibility requirements. If you can’t find a plan on the SHOP marketplace, you can find one directly through insurance company websites.
If you offer SHOP coverage, you must offer it to all full-time employees and have an office or worksite in the state where you’re applying for coverage. Not all providers offer SHOP plans, and they may not be available everywhere. Whether you decide to enroll in a SHOP plan or another group health insurance plan, you’ll want to choose a reputable company that prioritizes your employees and their healthcare needs. We evaluated companies based on the benefits they provide and their third-party ratings, so you can choose the right health insurance partner for your small business.
- Best Overall: Blue Cross Blue Shield
- Best for Telemedicine: Oscar
- Best for Customer Satisfaction: Kaiser Permanente
- Best for Extra Benefits: UnitedHealthcare
- Best Self-Insured Plans: Aetna
- Our Top Picks
Blue Cross Blue Shield
Kaiser Permanente
UnitedHealthcare
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Final Verdict
Methodology, best overall : blue cross blue shield.
Nationwide availability
Wide provider network
Offers a variety of workplace wellness programs
Blue365 provides employees with discounts on health products and services
J.D. Power rating varies by region
With coverage in every U.S. ZIP code and a variety of national networks to choose from, Blue Cross Blue Shield can meet the needs of almost any business. The company was also our top pick for the best health insurance provider overall. But since BCBS is a group of companies, benefits vary by region, as do customer satisfaction ratings. It’s important to evaluate your BCBS company for issues like customer complaints.
BCBS workplace wellness programs vary by state, but as an example, BCBS Mississippi trains company leaders to teach fitness classes, and offers a significant reduction in health insurance premiums for employees who commit to working out at least twice per week. Other benefit offerings vary by region as well, but Anthem offers 24/7 virtual care, a convenient mobile app, a variety of plan types, and the option to bundle health coverage with dental, vision, life, and/or disability insurance. And the Blue365 discount program provides your employees with robust discounts on wellness-related products and services.
Best for Telemedicine : Oscar
Oscar Insurance
$0 virtual urgent care available 24/7
Access to Cigna’s network with no referrals needed
A convenient mobile app with rewards for walking
Limited geographical availability
Oscar makes it easy for your employees to request virtual care from a convenient mobile app, and with most plans, there’s no cost to talk to a doctor online. Employees can also use the app to refill their prescriptions, message their care team, track their deductibles, and even get rewarded for meeting their step goals. What’s more, Oscar has partnered with Cigna to give members access to the company’s national and local provider networks. You can give your employees two network options, both of which don’t require specialist referrals and which include the Cigna Behavioral Health Network.
However, availability is limited to a few different states, cities, and metro areas: Georgia, Tennessee, Connecticut, select Arizona counties, select California counties, the Philadelphia metro area, Kansas City, Chicago, and St. Louis.
Best for Customer Satisfaction : Kaiser Permanente
Ranked highly by J.D. Power for customer satisfaction
4.3-star NCQA rating
Administers health payment accounts (HRA, HSA, or FSA) for deductible plans
Offers complementary care, vision, and dental plans
Kaiser Permanente received the best third-party member experience ratings of any insurer we reviewed. Its average NCQA rating is 4.3 stars (higher than all other providers). And it came in first for customer satisfaction in five of 22 regions—this is significant because it’s only available in eight states and Washington D.C. What’s more, Kaiser offers a range of health plan options, from PPO plans to deductible HMOs that can be paired with a health savings account or health reimbursement arrangement. And it’s affordable to add extra benefits for your employees, which include not only dental and vision, but also complementary care, such as acupuncture and chiropractic.
However, Kaiser Permanente plans are only available in California, Colorado, Georgia, Hawaii, Maryland, Virginia, Oregon, Washington, and the District of Columbia. And while the company provides resources and support for establishing a workplace wellness program, Kaiser is less hands-on than some Blue Cross Blue Shield companies when it comes to specific workplace programs. The company does, however, offer a variety of fitness discounts, and members can speak with a wellness coach at no cost.
Best for Extra Benefits : UnitedHealthcare
Offers a variety of extra benefits beyond just vision and dental
Offers options for part-time and seasonal workers
A+ (Superior) financial strength rating with AM Best
Customer satisfaction varies by region
UnitedHealthcare allows you to offer employees a variety of choices for plan types. It even provides bundled savings when you choose to offer additional coverage, such as vision, dental, hearing, and disability and absence benefits, plus supplemental, pet, and life insurance benefits. UnitedHealthcare also offers a unique program designed for part-time and seasonal workers, which is the only such program available nationwide. Level-funded and fully insured options are available for traditional major medical coverage, and a lower-cost, level-funded, limited minimum essential coverage option is also available. In addition, UHC offers a variety of workplace wellness programs, including a no-cost virtual weight loss program and rewards for physical activity. Group health plans include a discount program as well.
UnitedHealthcare also boasts relatively strong third-party ratings, with an average NCQA rating of 3.5 stars and an A+ (Superior) financial strength rating from AM Best, the highest grade of any of the featured providers on this list. However, the company’s customer satisfaction rating in the J.D. Power 2022 U.S. Commercial Member Health Plan Study varies by region. For example, the company was ranked lowest (out of seven providers) in Florida, but ranked second in the Heartland.
Best Self-Insured Plans : Aetna
Offers self-insured funding options
Offers a suite of more than 70 wellness programs
Dedicated support for new business onboarding
$0 MinuteClinic copays for self-insured members
MinuteClinic benefits not available to fully-insured groups in some states
If you’re looking for more plan flexibility and the possibility of greater savings, Aetna is our top pick for self-insured funding options. Self-funding with Aetna can save you as much as 25% on monthly costs, plus the insurer returns 50% of the surplus to your business. At the same time, stop-loss insurance protects you from unaffordable costs. HSA accounts are also available to employees, as are $0 copays for many MinuteClinic services. Just keep in mind that some fully-insured groups don’t get the same benefits.
Aetna also offers a suite of tools to members of self-insured plans, including a convenient mobile app that can provide rewards for reaching personalized goals, virtual care through Teladoc, and virtual fitness classes. The company also has an A (Excellent) financial strength rating with AM Best, and an average 3.3 NCQA star rating for its commercial plans, which indicates above-average member satisfaction. You can get group dental coverage through the provider as well. But Aetna’s group plans aren’t available everywhere.
Bear in mind that if you opt for self-insurance, you’ll be subject to IRS reporting requirements , regardless of your business size.
Blue Cross Blue Shield was our top pick all-around, and will be an especially good choice in regions where BCBS has high customer satisfaction ratings, robust workplace wellness programs, and other benefits. But if a convenient app with easy access to virtual care is most important to your employees, you may want to go with Oscar. And if you want the best customer experience for your employees, Kaiser is an excellent choice.
We recommend Aetna for small businesses pursuing self-insurance, and UnitedHealthcare is the best option for businesses that want the most extensive benefits package, especially those who want options for their variable-hour employees. Your budget and location may also limit your choices, but our top picks are all reputable providers that offer good coverage.
Frequently Asked Questions
How do i get health insurance for a small business.
If you’re self-employed, check the best health insurance companies for self-employed workers. Otherwise, you have a couple of options: The first is to work directly with a private insurer to get a fully-insured or self-funded plan. The second is to compare plans offered through the Small Business Health Insurance Options Program (SHOP), and to purchase coverage directly or with help from a broker.
While this program offers robust options in some states, others have limited or no plans available. Generally, getting SHOP coverage is the only way to claim the Small Business Health Care Tax Credit, which could save you up to 50% on your premium contributions. You must meet other eligibility requirements as well.
Do Small Businesses Have to Provide Health Insurance?
No employer is required to offer health coverage for its employees, but companies with at least 50 employees that do not offer health coverage are subject to the Employer Shared Responsibility Payment. If you choose to offer health insurance coverage to your full-time employees, you must offer it to all full-time employees once they become eligible, and there is a 90-day maximum waiting period.
How Much Does Small Business Health Insurance Cost?
Your total cost will depend on several factors, including the location of your business and the type of network you choose. In 2021, businesses with fewer than 200 employees spent an average of $6,569 per employee on annual health insurance premiums for single coverage and $14,094 for family coverage. Experts generally recommend keeping group health insurance costs between 10% and 20% of your annual revenue.
What Is a Self-Insured Health Plan?
A self-insured health plan is a type of group health insurance in which the employer collects premiums and is responsible for paying claims when employees need care. These plans can be self-administered, or the business may work with an insurance provider to get stop-loss coverage and administrative support.
There are several benefits to self-funded plans. Employers can keep surplus premiums (or receive a portion returned by the stop-loss carrier), plans can be customized to a greater degree, and certain ACA provisions that lead to high costs can be avoided. Increasingly, small businesses are opting for self-funded coverage. But self-insured plans aren’t right for every business.
We compared the largest health insurers nationwide and considered criteria in the following categories to determine the best health insurance companies for small businesses.
- Customer satisfaction : We used NCQA ratings and performance in the J.D. Power U.S. Commercial Member Health Plan Study to measure this criteria.
- State availability : This measure indicates how widely available plans are across the U.S.
- Plan features: For each company, we researched the types of plans available, plan features and benefits, the provider network, available wellness programs, and discounts.
- Types of employees covered: We considered whether coverage is available for full-time, part-time, and seasonal workers.
- Accessibility : We considered how easy it is for members to navigate plan services.
J.D. Power. “ 2022 U.S. Commercial Member Health Plan Study .”
KFF. “ Section 6: Worker and Employer Contributions for Premiums .”
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small-group health insurance
What is small-group health insurance.
In most states, small-group health insurance is medical insurance purchased by businesses with 50 or fewer full-time equivalent employees , to provide health coverage for the employees and their families. In four states , small group plans are sold to businesses with up to 100 employees (in most states, businesses with 51+ employees obtain coverage in the large group market, but in those four states, the large group market starts with businesses that have at least 101 employees).
How are small group health plans regulated?
Small-group plans effective since January 2014 are required to fully comply with Affordable Care Act ( ACA ) rules that apply to individual and small-group health plans.
Insurers can’t use a group’s medical history to set premiums for ACA-compliant small-group plans, and premiums for older employees cannot be more than three times those for younger employees. ACA-compliant small-group plans also have to fit into one of the four metal levels and cover the ACA’s essential health benefits with no dollar limits on how much the health plan will pay for a member’s treatment.
How can a business obtain small-group health insurance?
Businesses can buy small-group plans at any time of the year, directly from an insurance company, via a broker or private exchange, or from a state’s SHOP exchange (most states no longer have SHOP exchange plans available, but some do; in the District of Columbia , small group plans can only be obtained in the SHOP exchange).
In most states, insurers can impose participation requirements (in terms of the percentage of employees who sign up for the coverage) as well as employer contribution requirements (in terms of the amount of the premiums covered by the employer, as opposed to being payroll deducted). But there’s a one-month window each year, from November 15 to December 15 , when small group coverage is guaranteed-issue even to small groups that don’t meet the normal participation or contribution requirements.
Purchase of a SHOP plan may qualify the buyer for the Small Business Health Care Tax Credit . In states that use Healthcare.gov, SHOP plans are now purchased directly through the insurance companies, or with the help of a SHOP-certified broker .
Find out whether your business would benefit by providing small-group coverage for employees .
How can employees enroll in small-group health insurance?
When an employer purchases a small-group health plan, eligible employees are enrolled if they choose to accept the coverage. After that initial enrollment window, employees can sign up during an annual open enrollment period (set by the employer and the insurer), or during a special enrollment period triggered by a qualifying life event . Newly eligible employees can enroll as soon as they become eligible, which can be at any time of the year (for example, a new hire, or a person who transitions from part-time to full-time).
Are there any other alternatives for small groups to obtain health insurance?
Yes. Small groups can choose to self-insure rather than purchasing ACA-compliant health insurance from an insurance company. Self-insurance is the primary type of coverage used by large employers. And although it’s not as common among small employers, it is possible.
Another option is to use a QSEHRA or ICHRA , both of which involve the employer reimbursing employees for the cost of self-purchased health coverage.
Are small employers required to offer health coverage?
No, unless they have 50 full-time equivalent employees. As noted above, groups with up to 50 employees are considered small groups in most states. The ACA’s employer mandate requires employers with 50 or more employees to offer health coverage to full-time employees.
So there is that slight overlap: A business with exactly 50 full-time equivalent employees does have to offer coverage, and would be purchasing coverage in the small group market if they choose to purchase group coverage from an insurer. But as noted above, they could also choose to self-insure or use a reimbursement arrangement that lets the employees purchase their own coverage in the individual market (the reimbursement must be substantial enough that the self-purchased coverage would be considered affordable ).
Businesses with 49 or fewer full-time equivalent employees are not required to offer health coverage. Many do as a way to attract and retain employees, but there is no government requirement that they provide health benefits to their workers.
Related terms
- group health insurance
- SHOP exchange
Related articles
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Small Business Guide to Health Insurance (2023)
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electing a small business health insurance plan is one of many important decisions you’ll need to make as a small business owner.
To help you choose a health insurance plan that balances your budget and your employees’ healthcare needs, we’ve created this small business guide to health insurance.
Read on to get an overview of insurance requirements, costs and considerations, and recommendations for the best health insurance providers for small businesses.
How does small business health insurance work?
Rules can vary from state to state, but there are four basic rules of thumb when it comes to small business health insurance:
- Coverage cannot be denied based on pre-existing medical conditions. Coverage is almost always guaranteed.
- Typically, a business needs at least one employee to qualify.
- You can sign up any time of year, not just during open enrollment, with premiums usually locked for a year.
- Typically, employers will have to pay at least half of employees’ monthly premiums.
Are you required to provide health insurance?
Under the Affordable Care Act (ACA) , you are required to provide health insurance if you have fifty or more full-time employees. You may have to pay penalties if you don’t provide benefits to those employees who qualify. There may be additional criteria depending on where your business is based, so we highly recommend referencing your state laws and regulations.
Why should you offer small business health insurance?
Understandably, you may be worried about whether you can afford to provide health care coverage to your employees. While it will use up a portion of your business expenses, offering health insurance doesn’t need to be completely cost-prohibitive.
For instance, you can utilize health reimbursement arrangements or health savings accounts to help you and your employees afford health benefits. Whatever you choose, it’s a good idea to seek the help of a tax or financial professional who specializes in these sorts of matters to help you determine how it could affect your business financially.
Here are some of the top reasons to consider offering health insurance:
- Attract first-rate talent. A comprehensive benefits package demonstrates to job candidates that your business is competitive and prioritizes employee well-being.
- Improve employee retention. Raises aren’t the only way to keep employees. Glassdoor’s Employment Confidence Survey showed that 40% of employees value health insurance benefits more than a pay raise. Retaining employees means fewer costs associated with onboarding, training new workers, and interrupting business flow.
- Benefit from tax incentives. In most cases, you can deduct 100% of the cost of monthly premiums from federal taxes . You could also benefit from reductions in payroll tax and deductions from HSA contributions.
How much does health insurance for a small business cost?
Small business owners tend to be concerned about costs when offering group health insurance. There are plenty of health insurance options to ensure you stay within budget and increase health insurance coverage as you need to.
According to a 2022 Kaiser Family Foundation study , the average annual premium for employer-sponsored health insurance was $7,911 for single coverage, with the employer contributing $6,581 on average.
Cost to employer
Employers should expect to pay about 50% of insurance premiums for their employees. This is a requirement to qualify for the federal small-business healthcare tax credit. It is also often required by the insurance companies themselves.
Therefore, if the annual average in 2022 for health insurance for an individual was $7,911, you would have to pay about $3,955 a year for a single employee.
Cost to employees
With the introduction of the Affordable Care Act (ACA), the maximum out-of-pocket limit for 2023 is:
- $9,100 for individual coverage
- $18,200 for family coverage
The most budget-friendly option for group coverage is a high deductible, low premium plan. That way, your upfront out-of-pocket costs are lower. You might also look at options for low deductible, high premium plans if you or your employees carry different health needs – this will come at a higher cost.
In general, you’ll be able to choose from different tiers to see how much coverage other plans provide. Coverage options might look like this:
- Bronze Tier: 60% coverage, 40% deductible
- Silver Tier: 70% coverage, 30% deductible
- Gold Tier: 80% coverage, 20% deductible
- Platinum Tier: 90% coverage, 10% deductible
There are some insurance companies that offer the following types of tiers:
- No deductible plans: The plan provides all coverage.
- High deductible plans: With these plans, there are a significant amount of out-of-pocket expenses but with lower premiums.
- Low deductible plans: With these plans, there are some out-of-pocket expenses and higher premiums.
Don’t forget to factor in a plan’s total deductible and out-of-pocket limits. The entire plan cost will be the same as the deductible plus the monthly premium. This means that even if your premium seems low, it could end up more expensive compared to other plans once you factor in the total deductible.
It’s also essential to consider copays that your employees will need to pay. Some employees will want to set up a Health Reimbursement Account (HRA) or Health Savings Account (HSA). Make sure to look into where this fits into your group health insurance plans.
Factors that affect the cost of health insurance
In general, five factors will determine the cost of health insurance coverage:
- Choice of provider
- Type of plan selected
- Number of employees
- Demographics of your employees
- Qualifying tax credits
You’ll also find plans that differ by type of network. This will determine how accessible various doctors are to your employees. You’ll usually find the following options:
- Health Maintenance Organization (HMO). These plans are generally the most restrictive, as they require patients to choose from a list of approved doctors, do not include any out-of-network coverage, and will typically need referrals for specialists. However, HMOs tend to be the cheaper plan when compared to PPOs.
- Preferred Provider Organization (PPO). PPOs are generally the most flexible, as the patient can choose their own doctor and may not need approval to see specialists. They will also likely cover some out-of-network providers. However, they are usually the more expensive plan option.
- Exclusive Provider Organization (EPO). These plans have similarities to both HMOs and PPOs. With an EPO plan, there is no out-of-network coverage, but patients typically don’t need referrals for specialists.
How to Choose the Right Health Insurance for Your Small Business
In addition to understanding the components of health insurance plans outlined above, reviewing a plan’s eligibility features will help you determine what your employees will appreciate the most.
In most cases, health insurance plans will offer the following benefits:
- Outpatient care
- Inpatient care (including in-hospital stays)
- Pediatric services
- Preventative services
- Prescription drugs
- Emergency room visits
- Treatments for chronic conditions
- Pre- and post-natal care
- Mental health and substance abuse services
Take a careful look at what different plans offer as far as deductibles and coverage costs. There may be limits or caps in place to prevent employees from accessing too much of a particular type of service. Keep in mind that some employees may have dependents they wish to add to their health insurance coverage.
When choosing a health insurance plan, consider your employees’ needs and what they may benefit from the most. You may end up paying more upfront, but retaining your best employees will lead to a significant positive impact on your business's success in the long run.
Now that you know a little more about small business health insurance, let’s look at how to shop for affordable insurance options.
How to find affordable small business health insurance
- Seek out the providers directly. Contacting the insurance companies directly is the most straightforward option, though you may need to work with a broker depending on the provider. You can typically request a quote based on your location and headcount and then compare your options.
- Use SHOP. The Small business Health Options Program (SHOP) is available for employers with 1-50 full-time employees via the ACA. This program helps small businesses provide private health insurance options to their employees without needing to shop around (no pun intended). With SHOP, companies work with a registered broker to help select a plan, determine any tax credits, and assist employees with understanding their benefits.
- Consider PEOs. Professional Employer Organizations (PEOs) are great options for small businesses since they typically include large-business health insurance coverage as part of their offerings. In addition, they usually handle HR and administrative tasks like payroll.
Best health insurance companies for small business owners
These are a few of the top health insurance companies for small businesses, as well as an overview of each:
United Healthcare
Pros: United stands out for providing the largest network of providers. It also offers benefits options for part-time and seasonal employees, virtual therapy, and specialty healthcare, and is a leader in technology in the form of helpful in-app services.
Cons: United has been sued for wrongfully denied claims. It also does not offer a platinum plan.
Blue Cross Blue Shield
Pros: BCBS stands out for its customer service ratings. It operates in all 50 states (and some international locations) and has comprehensive healthcare offerings, including workplace wellness plans.
Cons: This service comes at a cost. BCBS has higher-than-average healthcare premiums and high deductibles.
Pros: Elevance is one of the most affordable insurers in this group. It offers numerous plan types and an extensive network of healthcare providers.
Cons: Elevance is only available in 14 states. It has a high rate of coverage denials which may explain its low customer satisfaction ratings.
Pros: Aetna places a strong emphasis on preventative treatments and encourages participants to make healthy lifestyle choices. It is also known for user-friendly experiences, whether online, in-app, or over the phone, and for its affordable prices.
Cons: Aetna only operates in 16 states and has a history of wrongfully denying claims. This may also explain its higher-than-average complaint rate.
Kaiser Permanente
Pros: Kaiser Permanente is the cheapest insurer in the group providing low prices for equivalent plan options. It has a wide range of available plans and runs a system of private hospitals only available to its plan participants.
Cons: It is only available in eight states and Washington D.C., and because it is a closed group, care options may be limited.
Pros: Humana offers participants the most flexibility to customize their plans, with add-ons like dental, vision, and hearing insurance.
Cons: Their plans are pricey compared to other insurers.
Pros: Cigna stands out because of its live customer service, accessible 24 hours a day, 365 days a year. It also gets excellent customer reviews and has a huge network of 1.5 million providers worldwide.
Cons: It is only available in 12 states, and its monthly premiums are expensive.
Alternatives to health insurance
You can utilize health reimbursement arrangements or offer health savings accounts (typically only available on high deductible health plans) to make benefits more affordable.
Additionally, there may be tax credits or other state services that are available to you depending on the size of your small business.
Affordable health insurance for your small business isn’t impossible to find! Carefully consider your budget and benefit options, as well as your employees’ needs, to choose the best plan.
You may end up paying more upfront, but think of this as the cost to retain key employees.
For more information, visit healthcare.gov to learn more about small business health insurance options, costs, and eligibility.
Novo Platform Inc. strives to provide accurate information but cannot guarantee that this content is correct, complete, or up-to-date. This page is for informational purposes only and is not financial or legal advice nor an endorsement of any third-party products or services. All products and services are presented without warranty. Novo Platform Inc. does not provide any financial or legal advice, and you should consult your own financial, legal, or tax advisors.
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Choosing a health care partner is one of the most important business decisions you can make. Kaiser Permanente can help you manage costs, invest in the health of your employees, and build a healthier future for your employees and your business. Choose Better. Choose Kaiser Permanente.
Check out small business plans with the right mix of coverage, cost, and convenience.
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Services covered under your health plan are provided and/or arranged by Kaiser Permanente health plans: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii • Kaiser Foundation Health Plan of Colorado • Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 • Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 • Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 • Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc., 1300 SW 27th St., Renton, WA 98057 • Self-insured plans are administered by Kaiser Permanente Insurance Company, One Kaiser Plaza, Oakland, CA 94612
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What You Need To Know About Group Health Insurance For Open Enrollment
Updated: May 10, 2022, 4:21pm
Nearly 50% of insured Americans receive health insurance coverage through group plans provided by employers, according to 2019 Census data. However, many of them may not have thought much about how exactly this group health insurance works.
Group health insurance provides many benefits, but when your insurance plan is tied directly to your employment, you risk a sudden loss of health coverage should your job situation change. In 2017, 22% of uninsured Americans reported losing their health insurance due to job loss or change in employment status.
Whether you recently started a new job and want to learn more about how your new group coverage works, you already have group coverage and want to know more about it, or you just lost or quit your job and worry you’ve lost health insurance coverage, this guide can help you understand the ins and outs of group health insurance.
What Is Group Health Insurance and How Does It Work?
Group health insurance—sometimes called employer-based coverage—is a type of health insurance plan offered by an employer of a member organization. Members of a group health insurance plan usually receive coverage at a lower cost because the risk to the insurer is distributed across multiple members.
Under the Affordable Care Act (ACA), businesses with 50 or more full-time employees must provide health insurance to full-time employees and dependents under the age of 26 or pay a fee. Insurers are also required to provide group coverage to organizations with as few as two employees. Some states allow self-employed individuals to qualify for group coverage plans as well.
Group health insurance plans are selected and purchased by companies or organizations and then offered to employees. In most states, a group insurance plan is required to have a 70% participation rate, though some states’ minimum rate is higher or lower.
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Benefits of Group Health Insurance Plans
Group health insurance policies have a number of advantages and benefits over individual plans. Many employers provide supplemental health plans, which include dental coverage, vision coverage and pharmacy coverage, either separately or as a bundle.
The main benefit group plans offer is lower premiums. According to 2018 research conducted by eHealth, a private online marketplace for health insurance, the average premium cost per individual in a group health insurance plan was $409 a month compared to $440 for an individual plan. In the same study, small group health plans had an average deductible of $3,140 a year compared to $4,578 for individual plans.
Additionally, family members and dependents can be added to group plans at an additional cost to members, which can assist families with sole providers or whose alternative or individual health plan options carry significantly higher prices.
Group health insurance plans provide numerous tax benefits to both the employer and employee. The money employers pay towards monthly premiums is tax-deductible, and employees’ premium payments can be made pre-tax, which may reduce their total taxable income.
Some smaller businesses may also qualify for the small business health care tax credit . The small business health care tax credit benefits an employer with fewer than 25 full-time employees who pays average wages of less than $50,000 a year, offers a qualified health plan through the Small Business Health Options Program (SHOP) Marketplace and pays at least 50% of the cost of health care coverage for each employee (but not for family or dependents).
Who Can Sign Up for Group Health Insurance?
To be eligible for group health insurance, an employee must be on payroll and the employer must pay payroll taxes. Individuals usually not eligible for group coverage include independent contractors, retirees and seasonal or temporary employees. Employees who are on unpaid leave are often ineligible for group coverage until they return to work.
Generally, group health insurance coverage must also be offered to an employee’s spouse and dependent children until age 26, though employers may choose to expand the age definition for child dependents. Employers may also opt to extend health benefits to unmarried partners of the same or opposite sex, and that coverage must mirror the coverage extended to spouses on the same plan.
How to Enroll in Group Health Insurance
To enroll in a group health care plan provided by your employer, ask about the deadline for enrollment once hired. If you miss this deadline, you might have to wait until the annual open enrollment period to join. Some employers may have waiting periods of up to 90 days before new employee health insurance kicks in. You won’t have to pay premiums during this time, but you won’t have access to any health care coverage, either.
Some group health insurance plans offer different tiers of coverage or supplemental coverage like dental, vision and/or pharmacy. During open enrollment periods, you can make decisions about these insurance choices your employer provides, as well as add or remove any dependents. If a major life event like marriage, the birth of a child or a spouse’s loss of employment changes your circumstances, you may be able to enroll these new dependents in your group health insurance plan outside the open enrollment period.
Where to Find Group Health Insurance Plans
The most common way to get group health insurance coverage is through an employer. If your employer doesn’t offer health insurance due to the small size of the company or if you’re unsatisfied with your employer’s coverage options, look into coverage through a membership organization. If you belong to a membership organization offering a group health plan, such as AARP, the National Association of Female Executives, the Writer’s Guild of America or the Freelancers Union, you may be able to get health insurance coverage through your membership.
Be wary of plans offered by some membership organizations, as many offer a “health services discount” plan, which may save you money on prescriptions but isn’t a true health insurance plan.
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Group Health Insurance for the Self-Employed
Approximately 25.7 million small businesses in 2017 were considered “nonemployers,” or businesses with no paid employees, according to a 2020 report from the U.S. Small Business Administration Office of Advocacy. If your business doesn’t have any employees, you’re considered a small group of one.
Even though you’re self-employed, you may be able to buy group health insurance for your company in certain states. Check with your state’s insurance department to determine whether your state allows group policies to be sold to groups of one.
What to Do If You Lose Your Group Health Benefits
If you lose your job, you may also lose your employer-sponsored group health insurance. You and your dependents may be able to keep this coverage through what’s called continuation coverage.
In 1985, Congress passed the Consolidated Omnibus Budget Reconciliation Act (COBRA), which allows employees who lose their jobs to buy group health coverage for themselves or for their families for a limited amount of time. Under COBRA, the same group insurance plan with the same benefits must be made available to the terminated worker; however, the former employee must pay the full cost—including whatever the employer has previously covered—of the plan.
Continuation coverage is often much more expensive than an individual health insurance plan, so consider the price, benefits and network of providers carefully before making the choice to keep your coverage through continuation coverage temporarily instead of moving to an individual plan.
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- Health Insurance Coverage of the Total Population . KFF. Accessed 9/17/2021.
- 27+ Affordable Care Act Statistics and facts . Policy Advice. Accessed 9/17/2021.
- What is the Average Cost of Small Business Health Insurance? eHealth. Accessed 9/17/2021.
- 2020 Small Business Profile . U.S. Small Business Administration Office of Advocacy. Accessed 9/17/2021.
- Group Health Plan . HealthCare.gov. Accessed 9/17/2021.
- What constitutes a group for health insurance? People Keep. Accessed 9/17/2021.
- Health Insurance During Employment . Legal Aid at Work. Accessed 9/17/2021.
- Offer SHOP health insurance . HealthCare.gov. Accessed 9/17/2021.
- Employer Health Insurance Versus Individual Plans . Medical Mutual. Accessed 9/17/2021.
- Small Business Health Care Tax Credit and the SHOP Marketplace . Internal Revenue Service. Accessed 9/17/2021.
- Eligible Employees and Dependents . Health Coverage Guide by Small Business Majority. Accessed 9/17/2021.
- Health Insurance Guide . California Department of Insurance. Accessed 9/17/2021.
- Available Through Professional and Trade Organizations . The Hartford. Accessed 9/17/2021.
- The Best Way to Buy Group Health Insurance for Self-Employed Workers . HealthMarkets. Accessed 9/17/2021.
- Health Insurance After Employment: COBRA . Legal Aid at Work. Accessed 9/17/2021.
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Chauncey grew up on a farm in rural northern California. At 18 he ran away and saw the world with a backpack and a credit card, discovering that the true value of any point or mile is the experience it facilitates. He remains most at home on a tractor, but has learned that opportunity is where he finds it and discomfort is more interesting than complacency.
Alena is a professional writer, editor and manager with a lifelong passion for helping others live well. Before coming to Forbes Health, Alena worked as a digital media consultant for both B2B and B2C health-focused companies for several years, building content strategies and leaning into the world of e-commerce. She is also a newly minted functional medicine certified health coach.
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A Guide to Small Business Health Insurance Requirements
by Karen McCandless | Updated Aug. 5, 2022 - First published on May 18, 2022
Image source: Getty Images
Health insurance is one of the biggest headaches for any HR department and small business. There are so many uncertainties around what kind of plan to provide, how much it will cost, how to administer the plan, and whether you even are required to provide a plan.
It doesn’t help that the rules and regulations have changed so much in recent years, from the introduction of the Affordable Care Act (ACA) by President Barack Obama in 2010, to attempts to repeal the act by the current administration, to the effect of the upcoming election on health insurance plans.
For small businesses trying to stay on the right side of the law while managing costs and trying to keep employees happy and healthy, this is all a lot to take in. That’s why we have created this guide that covers small business healthcare requirements and touches on the relevant health insurance laws.
1. What do small business owners need to know about health insurance requirements?
Some businesses are required by law to provide health insurance, while some are exempt. We’ll dive into these exemptions below, but there are basic requirements when it comes to providing health insurance to your employees.
Firstly, when you provide a health insurance plan, it must meet the benefit, coverage, and affordability standards set out in the ACA. You also have to offer all eligible employees some form of health insurance within the first 90 days of their employment.
2. Do small businesses have to provide health insurance under the ACA?
Small businesses that have fewer than 50 full-time employees (or the equivalent in part-time workers) do not have to provide health insurance under the ACA, which is sometimes referred to as Obamacare.
Since most small businesses have under 50 employees, this means most are exempt. If you have more than 50 full-time employees, you are required by law to provide health insurance.
The caveat to this is that laws do change, especially as political administrations change, so it’s important to have measures in place to keep up with the latest regulations. This could mean subscribing to industry publications and newsletters, consulting with legal experts, or even reading your HR software vendor’s blogs. The HR software Workday even provides training on dealing with the ACA.
Workday’s free training can help you get up to speed with the ACA. Image source: Author
3. What benefits are there to providing health insurance?
While you are under no legal obligation as a small business to provide health insurance, there are a number of reasons why you should consider it.
Providing health insurance will help you attract talent, as people prioritize benefits packages when searching for jobs. As a small business, you might not be able to offer the same compensation as large enterprises, but you can make up for that by offering attractive benefits, such as health insurance. In fact, two-thirds of businesses provide health insurance as a way to attract and retain workers.
Businesses often offer health insurance to attract and retain talent. Image source: Author
Also, a healthy workforce is a happy workforce, and prevention is better than needing to find a cure. Providing health insurance shows employees that you care about their well-being, boosting morale, improving satisfaction, and helping retain talent.
You also want to encourage your employees to look after their health -- both physical and mental -- as illness-related lost productivity costs US businesses about $530 billion per year.
There are also financial benefits to providing health insurance. You can normally deduct your contributions from your taxes, and there are also tax breaks that are offered on a state-by-state basis.
If you use the Small Business Health Options Program (SHOP) Marketplace to buy your health insurance, you may also be eligible for federal tax breaks or tax credits.
4. How can I purchase a health insurance plan?
There is more than one way to purchase a health insurance plan. Here are the most popular for small businesses:
- Group health insurance plans: You can buy these plans through the federally run SHOP Marketplace. This was the most popular choice for small businesses in the past, but due to the high costs and lack of flexibility, this is no longer an option for many companies.
- Qualified small employer health reimbursement arrangement (QSEHRA): Set up by Congress in December 2016, QSEHRA is becoming an increasingly popular choice for small businesses. Under this arrangement, businesses offer employees a tax-free monthly allowance, and employees then choose and pay for their own health care using that money. The advantages of QESHRA are that it gives employees the flexibility to choose their own plan and it’s considerably easier to manage from an administrative point of view.
- Association health plans: Small businesses can join with other small companies to buy large-group health insurance (which is reserved for companies with more than 50 employees). This works in the same way as a normal group health insurance policy.
5. How many employees do you need to qualify for group health insurance?
Group health insurance is a cost-effective way for small businesses to offer health insurance, as it’s cheaper than buying individual plans.
A company has to have fewer than 50 employees to qualify for group health insurance. You also have to have an office of some sort (even if it’s only a desk in a coworking space) in the state where you’re applying for coverage, and you need to enroll at least 70% of your uninsured employees.
If you’re a family-run business, you need to check your eligibility for group health insurance, as you need to have workers who are not related to or the spouse of the owner of the company. If you only employ family members, you’ll need to apply for a family health insurance plan instead. Sole proprietors also cannot apply for group health insurance.
Part-time employees and seasonal workers do not count as part of the group, but you can still choose to offer them group health insurance. You can also provide individual health insurance to specific workers alongside your group plan.
6. What is the minimum employer contribution for health insurance?
If you meet the requirements and you opt for a group health insurance plan, you have to pay at least half of the monthly health insurance premiums. You also have to allow employees to cover their dependent children until they are 26, even if they don’t live at home.
However, if you purchase health insurance through the QSEHRA, there are no minimum contribution requirements, and you can decide how much to give each employee each per month.
7. Do small-business employers have to report health insurance on Form W-2?
Under the ACA, employers must report the cost of coverage under an employer-sponsored group health plan on an employee’s Form W-2. The cost reported should include both the amount paid by the employer and the amount paid by the employee. You don’t have to report dental, vision, liability insurance, and wellness programs on these forms.
While you have to report health insurance costs on this form, that doesn’t mean that this contribution is taxable. Many companies are actually eligible for tax relief from these contributions.
8. Where can I get help to manage my health insurance plan?
Once you’ve chosen a small employer health insurance plan, you still have to administer this plan and ensure that it is cost-effective and meets the necessary requirements. That’s where HR software can help.
If you choose a solution like Zenefits , you can gain insight into how much your benefits are costing you, plus how many employees are enrolled in your health insurance plan. You can also give employees access to a self-service portal to help them understand more about the plan and easily enroll in it.
Zenefits provides insight into the cost of the benefits you provide employees. Image source: Author
Stay ahead of the game
Providing health insurance to employees can be costly, time-consuming, and complicated, but it can also be beneficial when it comes to attracting and retaining talent, boosting employee morale and satisfaction, and improving productivity levels. You need to weigh the options and decide on a way forward that’s best for your business.
Talk to legal experts, see what your employees think about whether health insurance is a priority, and seek advice from your HR software vendor , as they should have significant experience in benefits administration . And then do what’s best for you to be able to run your business smoothly. It’s an important decision, so don’t rush it.
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Sana Benefits - 5 types of group health insurance plans for small businesses
5 types of group health insurance plans for small businesses
Group health insurance plans for small businesses: An overview in America
In general, any health coverage option an employer offers to its employees and their families falls within the “group health plans” definition. You’ll see that term quite a bit when researching group health insurance plans for small businesses.
The Kaiser Family Foundation (KFF) performs systematic studies to generate trusted information on national health issues, including group employee health benefits . In 2020, KFF released its Employer Health Benefits Survey revealing health benefit trends. Here are a few pointers to show how small businesses (3-199 employees, per the study’s sample) are doing.
The majority of small businesses are offering health coverage
In the past, group health insurance plans for small businesses were more of a bonus than a staple benefit. Today, more companies of all sizes offer their employees health insurance plans, whether they cover the entire premium or not.
- Health plan offer: 55% of small firms offer health benefits to at least some of their staff.
- Premium payments: 27% of covered employees in small firms are in a plan where the employer pays the entire premium for single coverage, while 28% are in a plan where they must contribute more than 50% of the premium for family coverage.
Innovative insurance options
Even while most people are familiar with conventional, fully-funded healthcare coverage from traditional carriers, a significant portion of small companies choose alternative insurance options.
- Self-funded insurance modality: 67% percent of covered employees, including 23% of them who work in small firms, have self-funded plans.
- Level-funded insurance modality: Among covered employees in small firms, 31% are in a plan that is either self-funded or level-funded.
Modern benefits
Small business owners offer benefits beyond the more standard medical, dental, and visual care.
- Health risk assessment: 42% of small firms ask their employees to complete a health risk assessment, a questionnaire evaluating a person’s medical history, health status, and lifestyle.
- Biometric screening: 33% of small firms provide biometric screenings to their employees. These examinations measure a person’s health risk factors with indicators such as the body mass index (BMI), cholesterol, blood pressure, stress, and nutrition.
- Wellness programs: 53% of small firms offer a program related to smoking cessation, weight management, and behavioral or lifestyle coaching.
- Telemedicine: A higher number of smaller firms reported covering some services through telemedicine.
The data shows that the majority of American small business owners believe there are advantages to making group health insurance plans available for their staff. If it’s your first time choosing a plan or you’re looking into new carriers or plans, keep reading to discover the five primary types of insurance your company can access.
Related: Advantages of healthcare benefits for recruiting, retention and performance
1) fully-funded plans.
Traditional, large carriers offer fully-funded plans in which they take all the insurance policy risk. Your company pays a fee for the insurance company to manage claims and benefits for your employees.
These types of plans are becoming less common among small businesses because they are often relatively pricey, with little flexibility in plan options. Besides adding taxes and administrative costs, carriers charge small businesses more than larger companies with less risk due to the number of employees.
On the positive side of fully-funded plans, you will pay the same premium each month during the plan period, making budgeting more predictable. But don’t get too comfortable. Carriers typically raise your rates each year based on several factors they rarely reveal.
An individual assessment of your startup may make a fully-funded plan a more suitable option. For example, if you have a smaller number of employees, many of whom are older and file many claims, having the insurance company assume the risk could be the best choice for you.
2) Self-funded plans
In a self-insured or self-funded plan, the employer assumes the financial risk of the health policy. By choosing this among other types of group health insurance plans for small businesses, your company pays a more affordable, fixed fee to the carrier, plus employee medical claims as they come. Your and your employees’ contributions fund the plan.
However, with some self-funded plans, employers must pay for claims without a cap on how much they may have to pay. While the “pay-as-you-go” approach is advantageous when employees don’t file many claims, it could be risky in cases of catastrophic claims. Since the company assumes policy risk, fees could skyrocket in this scenario and blow your budget out of the water.
3) Level-funded
Like self-funded plans, the level-funded option allows employers to pay an affordable and predictable fixed monthly fee into its claims fund based on an estimate of eventual claims, plus a third-party administrator (TPA) fee to handle the benefits management.
However, there’s a substantial difference between self-funded and level-funded plans : the level-funded policy also includes a monthly cash flow stabilization component. In this type of group health insurance plans for small businesses, you pay as you go, with a cap on total possible costs, making your costs “level.”
When claims surpass the cap, stop-loss insurance kicks in to cover any overages. Even if employees file more or larger claims than expected, your company never has to pay more than your predetermined cap.
You only pay for what you use, giving you peace of mind your budget is safe. What happens when claims are lower than your payments? Your company receives a rebate check or credit after the end of the plan year for anything you overpaid. Top carriers will return 100% of the remaining funds.
Related: The first steps to shopping for business health insurance plans
4) professional employer organizations or peos .
Small businesses without a human resources department or benefits administrator often rely on Professional Employer Organizations (PEOs) to perform HR-related tasks, such as payroll, recruiting, compensation management, access to benefits, and compliance. One PEO typically works for a group of small companies, taking on the HR burden entirely.
A PEO can help your organization explore the insurance options available for your employees and obtain plan deals commonly available for large corporations. They rely on purchasing power to negotiate affordable benefits and insurance coverage.
It’s important to understand that when you work with a PEO, they become your employer of record as they take on the HR function for your company. That means you run your payroll under their tax ID numbers, not yours. They take on some risk, but you lose control and often won’t know how much you are really paying.
Gusto says , “To protect themselves, PEOs require you to adopt their policies, procedures, and even employee handbook wording. Because if an employee issue arises, they’ll back you up only if you’ve followed their guidance.”
With PEOs, you are stuck with whichever carriers and plans they choose. The lack of flexibility, transparency, and customer service often overshadow any benefits of a PEO. If you believe your business has less healthy than average employees, a PEO could help you mitigate that risk. However, if you are a relatively healthy company, the other businesses you are pooled with could make your insurance costs higher than they need to be.
5) Small Business Health Options Program (SHOP)
Getting insurance through the Small Business Health Options Program (SHOP, a part of the Affordable Care Act) applies to companies with up to 50 full-time employees.
SHOP plans are relatively flexible. According to Healthcare.gov :
- You can choose to cover medical and/or dental insurance.
- Your company can buy the plans directly or through a broker.
- You can offer a single plan or let your employees choose from multiple options.
- Your business can choose how much you pay toward your employees’ premiums and whether to offer coverage to their dependents or not.
- You can also decide how long new employees must wait before enrolling.
To see if your business qualifies for SHOP, you must complete an eligibility determination survey or explore the applicable rates and prices depending on your company’s location.
Which insurance option is the best for my business?
After exploring the primary types of group health insurance plans for small businesses, you may still wonder which option suits your company best. Offering health insurance to your employees is a commitment to them and the overall success of your company. It is a decision worth the time and resource investment.
To make the best decision, you have to consider your business’s budget, employee profile, and company size. You also need to determine what matters most to you. Do you want more plan flexibility, lower costs, better coverage, HR relief, predictable payments, less risk, or a combination of these? Each plan type has pros and cons, so weigh your options and choose one that most closely fits your specific needs.
Sana makes choosing modern, flexible, and affordable healthcare plans a breeze. Sana’s has a 98% customer service satisfaction score, and is ready to guide you through the options and find a comprehensive benefits package for your small business. Get a quote to find your ideal plan.
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How Much Does Small-Business Health Insurance Cost?
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- $7,813 for single coverage, of which employers contributed $6,485 , or 83%.
- $21,804 for family coverage, of which employers contributed $13,737 , or 63%.
What's the best fit for your business?
Answer a few questions and we'll match you with an insurance partner who can help you secure quotes.
How does small-group health insurance work?
How much do group health insurance premiums cost employers, employer contribution requirements, employee profile.
- The age of your employees and their dependents.
- Employees’ tobacco usage habits.
- Where your employees live.
The type of plan you pick
Industry and location, where can you buy small-group health insurance.
- Directly from an insurance provider in your state.
- Using an insurance broker. The broker will shop for policies tailored to your business. They’ll charge a commission (typically a percentage of the premium), and may also charge a broker’s fee. Some payroll products, such as Gusto and QuickBooks Payroll , allow you to buy health insurance from brokers on their platforms.
- Using the Small Business Health Options Program: SHOP is the federal government's insurance option for businesses with fewer than 50 full-time equivalent employees (up to 100 in some states). Most states require at least 70% of your eligible employees to participate in the SHOP health plan you offer.Businesses with fewer than 25 employees may qualify for a small-business health care tax credit worth up to 50% of premium costs.
- Using a Professional Employer Organization. A PEO is a company you can hire to administer benefits on your behalf. PEOs can legally become the co-employer of your employees. By serving as co-employer for multiple small companies, PEOs have a combined employee pool equivalent to that of a larger company. This gives them access to more competitive insurance rates than small businesses can typically get on their own.
- Qualify for QSEHRA . This is an arrangement for small businesses that offers employee reimbursement for qualified health expenses. Employees are not allowed to contribute through their paychecks and employer contribution terms to each employee’s QSEHRA must be the same.
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Self-insured funding built for small businesses
Control rising health care costs with Aetna Funding Advantage SM health plans. You can get the benefits typical for larger groups like surplus sharing, fewer taxes and fees and high-cost claims protection. All in one offering specially designed with your small business in mind.
A monthly payment based on the health trends of your employees — for up to 25 percent savings up front.
Online benefits shopping, enrollment, administration and other simple features for you and your employees.
Stop-loss insurance to limit the risk of high-cost claims, with money back when claims are lower.
Plan designs that provide access to Aetna’s quality, value-based network plus health and wellness benefits.
- Explore Aetna Funding Advantage benefits
A value-added package
You’ve come to the right place to balance health plan costs and quality. Explore competitive benefits, unique funding and stable cost control – with built-in wellness programs and resources to support employee health and well-being long term.
Get lower monthly payments based on health trends, low-cost local network options and 50% of any surplus returned to you at year end when you renew your plan.
Keep your costs predictable and stable with bundled products, funding options, wellness offerings, stop-loss claims protection and more.
Make life easy with a national portfolio of health insurance plan designs, online shopping and benefits administration and one common support model.
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We’ve got the perfect fully insured plan for you
Our health benefits and insurance plans are as unique as your small business, with service in markets all across the country. So it’s easy to find quality plans offered in your state.
Public exchange options are also available in selected states through our Small Business Health Options Program (SHOP) coverage .
Everyone saves with health expense funds
As part of a consumer-directed plan, health expense funds benefit employers and employees alike. You get tax savings from salary deductions. And employees get quality care that encourages smart spending.
You can also:
- Cut FICA, unemployment and workers’ comp taxes by lowering payroll taxes
- Offer innovative plans to set aside tax-free money, like for dependent care or parking expenses
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Licensee's use and interpretation of the American Society of Addiction Medicine’s ASAM Criteria for Addictive, Substance-Related, and Co-Occurring Conditions does not imply that the American Society of Addiction Medicine has either participated in or concurs with the disposition of a claim for benefits.
This excerpt is provided for use in connection with the review of a claim for benefits and may not be reproduced or used for any other purpose.
Copyright 2015 by the American Society of Addiction Medicine. Reprinted with permission. No third party may copy this document in whole or in part in any format or medium without the prior written consent of ASAM.
Precertification lists
Should the following terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button below labeled "I Accept".
- The term precertification here means the utilization review process to determine whether the requested service, procedure, prescription drug or medical device meets the company's clinical criteria for coverage. It does not mean precertification as defined by Texas law, as a reliable representation of payment of care or services to fully insured HMO and PPO members.
- Applies to: Aetna Choice ® POS, Aetna Choice POS II, Aetna Medicare ℠ Plan (PPO), Aetna Medicare Plan (HMO), all Aetna HealthFund ® products, Aetna Health Network Only ℠ , Aetna Health Network Option ℠ , Aetna Open Access ® Elect Choice ® , Aetna Open Access HMO, Aetna Open Access Managed Choice ® , Open Access Aetna Select ℠ , Elect Choice, HMO, Managed Choice POS, Open Choice ® , Quality Point-of-Service ® (QPOS ® ), and Aetna Select ℠ benefits plans and all products that may include the Aexcel ® , Choose and Save ℠ , Aetna Performance Network or Savings Plus networks. Not all plans are offered in all service areas.
- All services deemed "never effective" are excluded from coverage. Aetna defines a service as "never effective" when it is not recognized according to professional standards of safety and effectiveness in the United States for diagnosis, care or treatment. Visit the secure website, available through www.aetna.com, for more information. Click on "Claims," "CPT/HCPCS Coding Tool," "Clinical Policy Code Search."
- The five character codes included in the Aetna Precertification Code Search Tool are obtained from Current Procedural Terminology (CPT ® ), copyright 2022 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
- The responsibility for the content of Aetna Precertification Code Search Tool is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Precertification Code Search Tool. No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Precertification Code Search Tool should refer to the most Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT ® ")
- CPT only Copyright 2022 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. You, your employees and agents are authorized to use CPT only as contained in Aetna Precertification Code Search Tool solely for your own personal use in directly participating in health care programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT. Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to sue CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.
U.S. Government Rights
This product includes CPT which is commercial technical data and/or computer data bases and/or commercial computer software and/or commercial computer software documentation, as applicable which were developed exclusively at private expense by the American Medical Association, 515 North State Street, Chicago, Illinois, 60610. U.S. Government rights to use, modify, reproduce, release, perform, display, or disclose these technical data and/or computer data bases and/or computer software and/or computer software documentation are subject to the limited rights restrictions of DFARS 252.227-7015(b)(2) (June 1995) and/or subject to the restrictions of DFARS 227.7202-1(a) (June 1995) and DFARS 227.7202-3(a) (June 1995), as applicable for U.S. Department of Defense procurements and the limited rights restrictions of FAR 52.227-14 (June 1987) and/or subject to the restricted rights provisions of FAR 52.227-14 (June 1987) and FAR 52.227-19 (June 1987), as applicable, and any applicable agency FAR Supplements, for non-Department of Defense Federal procurements.
Disclaimer of Warranties and Liabilities.
CPT is provided "as is" without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. No fee schedules, basic unit, relative values or related listings are included in CPT. The American Medical Association (AMA) does not directly or indirectly practice medicine or dispense medical services. The responsibility for the content of this product is with Aetna, Inc. and no endorsement by the AMA is intended or implied. The AMA disclaims responsibility for any consequences or liability attributable to or related to any use, non-use, or interpretation of information contained or not contained in this product.
This Agreement will terminate upon notice if you violate its terms. The AMA is a third party beneficiary to this Agreement.
Should the foregoing terms and conditions be acceptable to you, please indicate your agreement and acceptance by selecting the button labeled "I Accept".
The information contained on this website and the products outlined here may not reflect product design or product availability in Arizona. Therefore, Arizona residents, members, employers and brokers must contact Aetna directly or their employers for information regarding Aetna products and services.
This information is neither an offer of coverage nor medical advice. It is only a partial, general description of plan or program benefits and does not constitute a contract. In case of a conflict between your plan documents and this information, the plan documents will govern.
Dental clinical policy bulletins
- Aetna Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits and do not constitute dental advice. Treating providers are solely responsible for dental advice and treatment of members. Members should discuss any Dental Clinical Policy Bulletin (DCPB) related to their coverage or condition with their treating provider.
- While the Dental Clinical Policy Bulletins (DCPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Dental Clinical Policy Bulletins (DCPBs) describe Aetna's current determinations of whether certain services or supplies are medically necessary, based upon a review of available clinical information. Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. Aetna's conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna). Your benefits plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between this policy and a member's plan of benefits, the benefits plan will govern. In addition, coverage may be mandated by applicable legal requirements of a State or the Federal government.
- Please note also that Dental Clinical Policy Bulletins (DCPBs) are regularly updated and are therefore subject to change.
- Since Dental Clinical Policy Bulletins (DCPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.
- Under certain plans, if more than one service can be used to treat a covered person's dental condition, Aetna may decide to authorize coverage only for a less costly covered service provided that certain terms are met.
Medical clinical policy bulletins
- Aetna Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits and do not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any Clinical Policy Bulletin (CPB) related to their coverage or condition with their treating provider.
- While the Clinical Policy Bulletins (CPBs) are developed to assist in administering plan benefits, they do not constitute a description of plan benefits. The Clinical Policy Bulletins (CPBs) express Aetna's determination of whether certain services or supplies are medically necessary, experimental and investigational, or cosmetic. Aetna has reached these conclusions based upon a review of currently available clinical information (including clinical outcome studies in the peer-reviewed published medical literature, regulatory status of the technology, evidence-based guidelines of public health and health research agencies, evidence-based guidelines and positions of leading national health professional organizations, views of physicians practicing in relevant clinical areas, and other relevant factors).
- Aetna makes no representations and accepts no liability with respect to the content of any external information cited or relied upon in the Clinical Policy Bulletins (CPBs). The discussion, analysis, conclusions and positions reflected in the Clinical Policy Bulletins (CPBs), including any reference to a specific provider, product, process or service by name, trademark, manufacturer, constitute Aetna's opinion and are made without any intent to defame. Aetna expressly reserves the right to revise these conclusions as clinical information changes, and welcomes further relevant information including correction of any factual error.
- CPBs include references to standard HIPAA compliant code sets to assist with search functions and to facilitate billing and payment for covered services. New and revised codes are added to the CPBs as they are updated. When billing, you must use the most appropriate code as of the effective date of the submission. Unlisted, unspecified and nonspecific codes should be avoided.
- Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member's benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply. The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered (i.e., will be paid for by Aetna) for a particular member. The member's benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary. If there is a discrepancy between a Clinical Policy Bulletin (CPB) and a member's plan of benefits, the benefits plan will govern.
- In addition, coverage may be mandated by applicable legal requirements of a State, the Federal government or CMS for Medicare and Medicaid members.
See CMS's Medicare Coverage Center
- Please note also that Clinical Policy Bulletins (CPBs) are regularly updated and are therefore subject to change.
- Since Clinical Policy Bulletins (CPBs) can be highly technical and are designed to be used by our professional staff in making clinical determinations in connection with coverage decisions, members should review these Bulletins with their providers so they may fully understand our policies.
- While Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, medical necessity determinations in connection with coverage decisions are made on a case by case basis. In the event that a member disagrees with a coverage determination, Aetna provides its members with the right to appeal the decision. In addition, a member may have an opportunity for an independent external review of coverage denials based on medical necessity or regarding the experimental and investigational status when the service or supply in question for which the member is financially responsible is $500 or greater. However, applicable state mandates will take precedence with respect to fully insured plans and self-funded non-ERISA (e.g., government, school boards, church) plans.
See Aetna's External Review Program
- The five character codes included in the Aetna Clinical Policy Bulletins (CPBs) are obtained from Current Procedural Terminology (CPT®), copyright 2015 by the American Medical Association (AMA). CPT is developed by the AMA as a listing of descriptive terms and five character identifying codes and modifiers for reporting medical services and procedures performed by physicians.
- The responsibility for the content of Aetna Clinical Policy Bulletins (CPBs) is with Aetna and no endorsement by the AMA is intended or should be implied. The AMA disclaims responsibility for any consequences or liability attributable or related to any use, nonuse or interpretation of information contained in Aetna Clinical Policy Bulletins (CPBs). No fee schedules, basic unit values, relative value guides, conversion factors or scales are included in any part of CPT. Any use of CPT outside of Aetna Clinical Policy Bulletins (CPBs) should refer to the most current Current Procedural Terminology which contains the complete and most current listing of CPT codes and descriptive terms. Applicable FARS/DFARS apply.
LICENSE FOR USE OF CURRENT PROCEDURAL TERMINOLOGY, FOURTH EDITION ("CPT®")
CPT only copyright 2015 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association.
You, your employees and agents are authorized to use CPT only as contained in Aetna Clinical Policy Bulletins (CPBs) solely for your own personal use in directly participating in healthcare programs administered by Aetna, Inc. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.
Any use not authorized herein is prohibited, including by way of illustration and not by way of limitation, making copies of CPT for resale and/or license, transferring copies of CPT to any party not bound by this agreement, creating any modified or derivative work of CPT, or making any commercial use of CPT. License to use CPT for any use not authorized herein must be obtained through the American Medical Association, CPT Intellectual Property Services, 515 N. State Street, Chicago, Illinois 60610. Applications are available at the American Medical Association Web site, www.ama-assn.org/go/cpt.
Go to the American Medical Association Web site
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Group health & life insurance
Find the right coverage for your employees.
When it comes to group health insurance, your business should benefit too.
Group health is the #1 benefit that employees desire when evaluating a new role. 1 Business health insurance helps to keep your employees healthy and productive.
Learn how ADPIA can help you navigate group health insurance and find smart solutions for your business.
Healthier employees = a healthier bottom line
Typically available to a company of two or more employees and their families, there are several reasons why it makes good business sense to offer group health insurance.
Stay competitive
Employees want to work for companies with the best compensation and benefits. Offering a comprehensive employee benefits package makes it more likely you'll attract and retain top talent.
Increase productivity
A healthy workforce can be a more productive one. Group health insurance helps create a healthy environment through prevention and wellness.
Enjoy lower rates
Business health insurance is typically more affordable than an individual policy. Businesses generally enjoy lower premiums because the more people in an employer health insurance plan, the lower the health insurance costs for everyone.
Putting the pieces together:
How do you choose the right benefits? You need the right partner. Automatic Data Process Insurance Agency, LLC (ADPIA®), can help. Our licensed agents have the knowledge and experience to help you pick the right coverage to meet your employees' overall health and wellness needs, including:
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Insights, options and service
At ADPIA, we provide access to a wide range of group health insurance plans. We connect you with one of our carrier partners, while offering guidance and support.
We can also connect you to a carrier network with additional products like flexible spending accounts (FSA), health savings accounts (HSA) and health reimbursement arrangements (HRA).
As your needs grow and change
As your company grows — and as industry regulations change — you may need to reassess your health insurance needs. We'll get to know your business and help you determine what coverage is right for your situation.
Common questions about group health insurance
Group health insurance is an employee benefit provided by an employer that offers medical coverage to employees and sometimes their spouses, partners and/or legal dependents.
If you have a business that employs two or more people, you're eligible to purchase group health insurance for your business. By pooling employees together, premiums for group health insurance plans can be less expensive than buying individual plans for your employees. In addition, employer-paid premiums are generally tax-deductible. Your employees' contributions to their premiums can be paid with pre-tax dollars, which lowers your employees' taxable income as well as your payroll taxes. Individual plan premiums are determined by individual risk (and may result in a higher cost) and individuals must reach 7.5% of their adjusted gross income in medical expenses in order to deduct any excess from their taxes.
According to a Kaiser Family Foundation survey, small employers (3-199 employees) typically pay 86% of premiums for single-employee coverage and 66% of premiums for family coverage. Midsized firms (200-999 employees) pay 88% of single-employee premiums and 82% of family premiums. Large firms (1,000-4,999 workers) pay 89% of single employee premiums and 77% of family premiums.
According to ACA, waiting time cannot exceed 90 days and some states have adopted a 60-day maximum waiting period.
Health insurance companies use one of three methods to calculate your group health insurance premium: medical underwriting, adjusted or modified community rating, or rating bands. The process used depends on the rules in your state. Please contact a licensed ADPIA agent for more detailed information.
Employers have a choice to select the coverage and plans that are best suited for their business and employees. Group insurance plans can include a range of coverage, including but not limited to: medical, dental, vision, life, short-term and long-term disability, etc.
Health insurance helps protect the personal health of the business owner and its employees, as well as the financial health of the business. Group health coverage can relieve some of the financial fears of getting sick and help employees to stay health. Today, health insurance can also be a top benefit factor in attracting and retaining talented workers.
A carrier cannot deny coverage on the grounds of a pre-existing medical condition, depending on circumstances.
Finding the plan that works best for both you and your employees is a matter of balancing your coverage and budget needs. Some insurance plans provide copayment coverage for most routine needs: annual physicals or monitoring a health condition. Plans of this type cover doctors' visits and prescriptions with a known copayment. The premiums for these plans reflect this level of coverage. Other insurance plans offer a higher deductible, which results in a lower premium, but have higher out-of-pocket costs until the deductible and any coinsurance requirements are met. This type of plan provides coverage for significant medical expenses and can work for people who don't anticipate frequent trips to the doctor.
Plan deductible - The expenses a member must cover before the insurer covers expenses. The lower the plan deductible, the higher the premium. Out-of-pocket limit - The maximum annual amount the insurer will require a member to contribute toward the cost of care. The lower the out-of-pocket limit, the higher the premium. Coinsurance level - The percent of the allowed amounts for covered services that the insurer will pay after the deductible is met. Plans range 50% to 100%. Copayment for services - The fixed dollar amount that's due when the covered service is provided. In most cases, this is the only cost that the member is responsible for paying – the plan covers the majority of the cost of services.
For a small business owner, it's important to understand the minimum participation requirements necessary for group plan eligibility. Though requirements vary by state, the following generally serve as an industry-standard regarding group health insurance plan participation:
A minimum of at least 75% of "net eligible" or 50% of "total eligible" employees participate in the health plan.
"Total eligible" employees are the sum of all eligible employees (full-time working>30hr/week).
"Net eligible" employees are the total eligible employees minus those eligible employees who have credible coverage through elsewhere (i.e., through a spouse, Medicare, etc.)
Why ADPIA? Here’s what our clients have to say…
9 out of 10
clients say that switching to ADPIA was easy.
clients agree ADPIA has simplified their insurance administrative process compared to their previous agency or broker.
clients prefer ADPIA over their previous agency or broker.
ADPIA clients are more likely to recommend ADPIA than their previous agency or broker, to another small business.
Internal survey of 589 ADPIA® clients in 2022 that used another insurance agent or broker or dealt directly with the insurance company before coming to ADPIA.
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1 *ADP, in partnership with SourceMedia Research/Employee Benefit News, conducted an online survey in August 2019 of more than 5,000 employees of small businesses as well as employees open to new employment in businesses of any size.
Stay Covered When Medi-Cal Renewals Begin
Medi-Cal renewals will start again soon. To stay covered, Medi-Cal members will need to take action.
If you’re concerned about losing coverage, we can connect you to the right options for you and your family.
Talk to a health plan consultant : TFN
New member? Register now , or download the Sydney Health app to access your benefits, ID card, pharmacy info, and more.
Understand your care options ahead of time so you can save time and money.
Make your mental health a priority. Explore our resources .
Individual & Family Plans
We offer affordable health, dental, and vision coverage to fit your budget. Plus, you may qualify for financial help to lower your health coverage costs.
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Find a Medicare plan that fits your healthcare needs and your budget. Compare plans available in your area and apply today.
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As one of the nation’s leading health plans, Anthem has invested the time and resources necessary to fully understand and serve millions of members in state-sponsored programs across the country.
Small Business Plans
Our small business plans offer a full range of health insurance options for groups with 2 to 50 or 100 employees, depending on your state.
For Employers
We offer flexible group insurance plans for any size business. Employers can choose from a variety of medical, pharmacy, dental, vision, life, and disability plans.
Manage Your Health Plan All In One Place
Your online account is a powerful tool for managing every aspect of your health insurance plan. Whether you need to check on a claim, pay a bill, or talk to a representative, you can easily access all your member features.
Quickly and easily submit out-of- network claims online.
Review medical and pharmacy benefits for up to three years.
Pay outstanding doctor bills and track online or in-person payments.
Price a medication, find a pharmacy, order auto refills, and more.
Access your member ID card from our website or mobile app.
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Find answers to all your questions with an Anthem representative in real time. Use our app, Sydney Health, to start a Live Chat.
Stay Healthy — Stay Informed
We’ve got the latest advice, tips, and news to help you get the most out of your benefits, find the best healthcare, and stay healthy.
Advancing Health Equity for the Black Community
January 10, 2023
Health equity means that everyone has the chance to be their healthiest.
Protect your health with regular mammograms
September 14, 2022
Taking time for routine mammograms is an important part of staying healthy.
Monkeypox: What You Need to Know
August 23, 2022
As the monkeypox outbreak spreads across the United States, you may have a lot of questions and concerns.
Important member notice: Learn about a vendor security incident .
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Not connected with or endorsed by the U.S. Government or the federal Medicare program.
The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent or insurance company. This policy has exclusions, limitations, and terms under which the policy may be continued in force or discontinued. For costs and complete details of the coverage, please contact your agent or the health plan.
Attention: If you speak any language other than English, language assistance services, free of charge, are available to you. Call our Customer Service number, (TTY: 711).
ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame a nuestro número de Servicio de Atención al Cliente (TTY: 711).
注意：如 果您使用非英語的其他語言，您可以免費獲得語言援助服務。請致電聯絡客戶服務部（聽語 障用戶請致電：711）。
Note: A member’s benefits booklet identifies if the plan is regulated by the Department of Managed Health Care or the Department of Insurance. In accordance with state requirement, Anthem publishes the notices of language assistance supporting our members.
CA Dept. of Insurance
Curious to know what all this says? We would be too. Here’s the English version:
No Cost Language Services. You can get an interpreter. You can get documents read to you and some sent to you in your language. For help, call us at the number listed on your ID card or 1-888-254-2721. For more help call the CA Dept. of Insurance at 1-800-927-4357. (TTY/TDD: 711)
Other Languages
Servicios lingüísticos sin costo. Puede tener un intérprete. Puede solicitar que le lean los documentos y algunos puede recibirlos en su idioma. Para obtener ayuda, llámenos al número que figura en su tarjeta de identificación o al 1-888-254-2721. Para obtener ayuda adicional, llame al Departamento de Seguros de California al 1-800-927-4357. (TTY/TDD: 711)
قرأُ يتم تقديم خدمات اللغة دون مقابل .يمكنك الاستعانة بمترجم .ويمكنك المطالبة بأن ت لك بعض المستندات وأن رسل ُي بعضھا بلغتك .للحصول على المساعدة، للحصول على مزيد من المساعدة، رجى .1- 888-254-2721 اتصل بنا على الرقم الموجود على بطاقة التعريف الخاصة بك أو على الرقم ُي الاتصال بإدارة (711 :TDD/TTY) .1- 800-927-4357 كاليفورنيا للتأمين على الرقم
Թարգմանչական անվճար ծառայություններ: Մենք կարող ենք Ձեզ թարգմանչի ծառայություններ առաջարկել Կարող ենք տրամադրել ինչ-որ մեկին, ով փաստաթղթերը կկարդա Ձեզ համար և կուղարկի դրանք Ձեր լեզվով: Օգնություն ստանալու համար զանգահարեք մեզ Ձեզ ID քարտի վրա նշված հեռախոսահամարով կամ 1-888-254-2721 համարով: Լրացուցիչ օգնության համար զանգահարեք Կալիֆոռնիայի ապահովագրության նախարարություն հետևյալ հեռախոսահամարով՝ 1-800-927-4357: (TTY/TDD: 711)
免費語言服務。您能獲得免費的譯員。您能聽到以您的語言讀出的文件內容，也能獲得以您的語言而寫的部分文件。 如需協助，請撥打您的 ID 卡上的號碼或者 1-888-254-2721 聯絡我們。如需更多協助，請撥打 1-800-927-4357 聯絡 CA Dept. of Insurance。(TTY/TDD: 711)
خدمات رايگان زبانی .می می توانيد يک مترجم شفاھی بگيريد . توانيد بخواھيد اسناد را برای شما بخوانند و برخی اسناد نيز به زبان خودتان برايتان ارسال شود .برای دريافت کمک، از طريق شماره فھرست شده در کا شناسايی رت 25 -2721 تان و يا از طريق 4-8881- با ما تماس بگيريد .برای دريافت . 1- 800-927-4357 کمکھای بيشتر با اداره بيمه کاليفرنيا به شماره (711 :TDD/TTY) تماس بگيريد
िबना लागत की भाषा सेवाएँ। आप दुभािषया प्रात कर सकते ह। आप दतावेज़ पढ़वा सकते ह और कुछ दतावेज़ आपको आपकी भाषा म भेजे जा सकते ह। मदद के िलए, हम अपने ID काडर् पर सूचीबद्ध नंबर पर या 1-888-254-2721 पर कॉल कर। अिधक मदद के िलए 1-800-927-4357 पर CA बीमा िवभाग कोकॉल कर। (TTY/TDD: 711)
Tsis Xam Tus Nqi Cov Kev Pab Cuam Ntsig Txog Hom Lus. Koj muaj peev xwm tau txais ib tus neeg txhais lus. Koj muaj peev xwm tau txais cov ntaub ntawv nyeem ua koj hom lus rau koj mloog thiab yuav xa ib co ntaub ntawv sau ua koj hom lus tuaj rau koj. Txog rau kev pab, hu rau peb tus nab npawb xov tooj teev tseg cia nyob rau ntawm koj daim ID los sis 1-888-254-2721. Txog rau kev pab ntxiv, hu xov tooj rau Pab Kas Phais Lub Chaw Ua Hauj Lwm CA tus xov tooj 1-800-927-4357. (TTY/TDD: 711)
無料言語サービス。通訳サービスを受けられます。希望する言語で文書を読み上げたり、文書を送るサービスも 可能です。支援を受けるには、IDカードに記載された番号、または 1-888-254-2721 にお電話ください。支援の 詳細は、カリフォルニア州保険局（1-800-927-4357）にお電話ください。(TTY/TDD: 711)
េសវាភាសាឥតគិតៃថល។ អនកអាចទទួលអនកបកែរបមាន ក់។ អនកអាចឲយេគអានឯកសារេផសងៗជូនអនក និងេផញើឯកសារជូនអនកជាភាសារបស់អនក។ េដើមបីទទួលជំនួយ សូមេហៅ ទូរស័ពទមកេយើងតាមេលខែដលបានរាយេនៅេលើប័ណណ ID របស់អនក ឬក៏េលខ 1-888-254-2721។ េដើមបីទទួលជំនួយបែនថម សូមេហៅទូរស័ពទេទៅ CA Dept. of Insurance តាមេលខ 1-800-927-4357។(TTY/TDD: 711)
무료 언어 서비스. 번역사를 이용하실 수 있습니다. 귀하의 언어로 녹음되어 작성된 문서를 받아보실 수 있습니다. 도움을 받으시려면 ID 카드에 기재된 번호 또는 1-888-254-2721로 전화하십시오. 다른 도움이 필요하시면 1-800-927-4357로 보험 CA 부서에 문의 주십시오. (TTY/TDD: 711)
ਿਬਨਾਂ ਿਕਸੇ ਲਾਗਤ ਦੇ ਭਾਸ਼ਾ ਸੇਵਾਵਾਂ। ਤੁਸ ਇੱ ਕ ਦੁਭਾਸ਼ੀਆ ਪ੍ਰਾਪਤ ਕਰ ਸਕਦੇ ਹੋ। ਕੋਈ ਤੁਹਾ ੰਨੂ ਦਸਤਾਵਜ਼ੇ ਪੜ੍ਹ ਕੇ ਸੁਣਾ ਸਕਦਾ ਹੈ ਅਤੇ ਕੁਝ ਤੁਹਾਡੀ ਭਾਸ਼ਾ ਿਵੱ ਚ ਤੁਹਾ ੰਨੂ ਭੇਜੇ ਜਾ ਸਕਦੇ ਹਨ। ਮਦਦ ਲਈ, ਸਾ ੰਨੂ ਤੁਹਾਡੇ ਆਈਡੀ ਕਾਰਡ ਉੱਤੇ ਸੂਚੀਬੱ ਧ ੰਨਬਰ ਜਾਂ 1-888-254-2721 ਤੇ ਕਾਲ ਕਰੋ। ਿਜ਼ਆਦਾ ਮਦਦ ਲਈ, ਸੀਏ ਿਡਪਾਰਟਮਟ ਔਫ ਇਨਸ਼ੋਰਸ ੰਨੂ 1-800-927-4357 ਤੇ ਕਾਲ ਕਰੋ।(TTY/TDD: 711)
Бесплатные языковые услуги. Вы можете получить услуги устного переводчика. Вам могут прочитать документы или направить некоторые из них на вашем языке. Для получения помощи звоните нам по телефону, указанному на вашей идентификационной карте, или по номеру 1-888-254-2721. Для получения дополнительной помощи звоните в Департамент страхования штата Калифорния по номеру 1-800-927-4357. (TTY/TDD: 711)
Mga Libreng Serbisyo para sa Wika. Maaari kayong kumuha ng interpreter. Maaari ninyong ipabasa ang mga dokumento at ipadala ang ilan sa mga ito sa inyo sa wikang ginagamit ninyo. Para sa tulong, tawagan kami sa numerong nakalista sa inyong ID card o sa 1-888-254-2721. Para sa higit pang tulong, tawagan ang CA Dept. of Insurance sa 1-800-927-4357. (TTY/TDD: 711)
ไมม่คี่าบริการเกี่ยวกับภาษา ท่านสามารถขอใช ้บริการล่ามได ้ท่านสามารถขอให ้เจ ้าหน้าทอี่่านเอกสารได ้ท่านฟังและเอกสาร บางอย่างจะส่งถึงท่านโดยใช ้ภาษาของท่าน หากต ้องการความช่วยเหลอื โปรดโทรหาเราตามหมายเลขที่ระบุอยู่บนบัตร ประจําตัวของท่านหรือที่หมายเลข 1-888-254-2721 หากต ้องการความช่วยเหลือเพิ่มเตมิ โปรดโทรติดต่อแผนก CA Dept. of Insurance ที่หมายเลข 1-800-927-4357 (TTY/TDD: 711)
Các Dịch Vụ Ngôn Ngữ Miễn Phí. Quý vị có thể có thông dịch viên. Quý vị có thể yêu cầu đọc tài liệu cho quý vị nghe và yêu cầu gửi một số tài liệu bằng ngôn ngữ của quý vị cho quý vị. Để được trợ giúp, hãy gọi cho số được ghi trên thẻ ID của quý vị hoặc số 1-888-254-2721. Để được giúp đỡ thêm, hãy gọi cho Sở Bảo Hiểm California (California Department of Insurance) theo số 1-800-927-4357. (TTY/TDD: 711)
CA Dept. of Managed Health Care
IMPORTANT: Can you read this letter? If not, we can have somebody help you read it. You may also be able to get this letter written in your language. For free help, please call right away at 1-888-254-2721. (TTY/TDD: 711)
IMPORTANTE: ¿Puede leer esta carta? De lo contrario, podemos hacer que alguien lo ayude a leerla. También puede recibir esta carta escrita en su idioma. Para obtener ayuda gratuita, llame de inmediato al 1-888-254-2721. (TTY/TDD: 711)
اً مهم :هل يمكنك قراءة هذه الرسالة؟ إذا لم تستطع، فيمكننا الاستعانة بشخص ما ليساعدك على قراءتها .كما يمكنك اً أيض الحصول على هذا الخطاب مكتوب بلغتك . اً للحصول على المساعدة المجانية، ُيرجى الاتصال 711 ( .1-888-254-2721 فور بالرقم :TTD/TTY)
ՈՒՇԱԴՐՈՒԹՅՈՒՆ. Կարողանո՞ւմ եք ընթերցել այս նամակը: Եթե ոչ, մենք կարող ենք տրամադրել ինչ-որ մեկին, ով կօգնի Ձեզ՝ կարդալ այն: Կարող ենք նաև այս նամակը Ձեզ գրավոր տարբերակով տրամադրել: Անվճար օգնություն ստանալու համար կարող եք անհապաղ զանգահարել 1-888-254-2721 հեռախոսահամարով: (TTY/TDD: 711)
重要事項：您能看懂這封信函嗎？如果您看不懂，我們能夠找人協助您。您有可能可以獲得以您的語言而寫的本信 函。如需免費協助，請立即撥打1-888-254-2721。(TTY/TDD: 711)
مهم :آيا میتوانيد اين نامه را بخوانيد؟ اگر نمیتوانيد، میتوانيم شخصی را به شما معرفی کنيم تا در خواندن اين نامه شما را کمک کند .همچنين میتوانيد اين . تماس بگيريد 1-888-254-2721 نامه را به صورت مکتوب به زبان خودتان دريافت کنيد .برای دريافت کمک رايگان، همين حالا با شماره (711 :TTD/TTY)
महत्वपूर्ण: क्या आप यह पत्र पढ़ सकते हैं? अगर नह ीं, तो हम आपको इसे पढ़ने में मदद करने के लिए ककसी को उपिब्ध करा सकते हैं। आप यह पत्र अपनी भाषा में लिखवाने में भी सक्षम हो सकते हैं। ननिःशुल्क मदद के लिए, कृपया 1-888-254-2721 पर तुरींत कॉि करें। (TTY/TDD: 711)
TSEEM CEEB: Koj puas muaj peev xwm nyeem tau daim ntawv no? Yog hais tias koj nyeem tsis tau, peb muaj peev xwm cia lwm tus pab nyeem rau koj mloog. Tsis tas li ntawd tej zaum koj kuj tseem yuav tau txais daim ntawv no sau ua koj hom lus thiab. Txog rau kev pab dawb, thov hu tam sim no rau tus xov tooj 1-888-254-2721. (TTY/TDD: 711)
重要：この書簡を読めますか？もし読めない場合には、内容を理解するための支援を受けることができます。また、この書簡を希望 する言語で書いたものを入手することもできます。次の番号にいますぐ電話して、無料支援を受けてください。 1-888-254-2721 (TTY/TDD: 711)
សំខាន់៖ តតើអ្នកអាចអានលិខិតតនេះតេ? ត ើមិនអាចតេ ត ើងអាចឲ្យនរណាម្ននក់អានវាជូនអ្នក។ អ្នកក៏អាចេេួលលិខិតតនេះតោ សរតសរជាភាសារ ស់អ្នកផងដែរ។ តែើមបីេេួលជំនួ ឥតគិតថ្លៃ សូមតៅេូរស័ព្ទភាៃមៗតៅតលខ 1-888-254-2721។ (TTY/TDD: 711)
중요: 이 서신을 읽으실 수 있으십니까? 읽으실 수 없을 경우 도움을 드릴 사람이 있습니다. 귀하가 사용하는 언어로 쓰여진 서신을 받으실 수도 있습니다. 무료 도움을 받으시려면 즉시 1-888-254-2721로 전화하십시오. (TTY/TDD: 711)
ਮਹੱਤਵਪੂਰਨ: ਕੀ ਤੁਸੀਂ ਇਹ ਪੱਤਰ ਪੜ੍ਹ ਸਕਦੇ ਹੋ? ਜੇ ਨਹੀਂ, ਤ ਾਂ ਅਸੀਂ ਇਸ ਨੂੂੰ ਪੜ੍ਹਨ ਵਵੱਚ ਤੁਹ ਡੀ ਮਦਦ ਲਈ ਵਕਸੇ ਨੂੂੰ ਬੁਲ ਸਕਦ ਹ ਾਂ ਤੁਸੀਂ ਸ਼ ਇਦ ਪੱਤਰ ਨੂੂੰ ਆਪਣੀ ਭ ਸ਼ ਵਵੱਚ ਵਲਵਿਆ ਹੋਇਆ ਵਬੀ ਪਰ ਪਤ ਕਰ ਸਕਦੇ ਹੋ। ਮੁਫ਼ਤ ਮਦਦ ਲਈ, ਵਕਰਪ ਕਰਕੇ ਫੌਰਨ 1-888-254-2721 ਤੇ ਕ ਲ ਕਰੋ। (TTY/TDD: 711)
ВАЖНО. Можете ли вы прочитать данное письмо? Если нет, наш специалист поможет вам в этом. Вы также можете получить данное письмо на вашем языке. Для получения бесплатной помощи звоните по номеру 1-888-254-2721. (TTY/TDD: 711)
MAHALAGA: Nababasa ba ninyo ang liham na ito? Kung hindi, may taong maaaring tumulong sa inyo sa pagbasa nito. Maaari ninyo ring makuha ang liham na ito nang nakasulat sa ginagamit ninyong wika. Para sa libreng tulong, mangyaring tumawag kaagad sa 1-888-254-2721. (TTY/TDD: 711)
หมายเหตุส าคัญ: ทา่นสามารถอา่นจดหมายฉบับนหี้รอืไม่ หากทา่นไม่สามารถอา่นจดหมายฉบับนี้ เราสามารถจัดหาเจา้หนา้ทมี่าอา่นใหท้า่นฟังได้ ท่านยังอาจให้เจ้าหน้าที่ช่วยเขียนจดหมายในภาษาของท่านอีกด้วย หากต้องการความช่วยเหลือโดยไม่มีค่าใช้จ่าย โปรดโทรตดิตอ่ทหี่มายเลข 1-888-254-2721 (TTY/TDD: 711)
QUAN TRỌNG: Quý vị có thể đọc thư này hay không? Nếu không, chúng tôi có thể bố trí người giúp quý vị đọc thư này. Quý vị cũng có thể nhận thư này bằng ngôn ngữ của quý vị. Để được giúp đỡ miễn phí, vui lòng gọi ngay số 1-888-254-2721. (TTY/TDD: 711)
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California Geographic Rating Areas: Including State Specific Geographic Divisions
The state specific geographic rating areas, including specific geographic divisions for the Individual and Small Group market in California are:
- March 5, 2020 Information Related to COVID–19 Individual and Small Group Market Insurance Coverage
- March 12, 2020 FAQs on Essential Health Benefits Coverage and the Coronavirus (COVID-19)
- March 18, 2020 FAQs on Catastrophic Plan Coverage and the Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
- March 24, 2020 Payment and Grace Period Flexibilities Associated with the COVID-19 National Emergency
- March 24, 2020 FAQs on Prescription Drugs and the Coronavirus Disease 2019 (COVID-19) for Issuers Offering Health Insurance Coverage in the Individual and Small Group Markets
- April 11, 2020 FAQs about Families First Coronavirus Response Act and the Coronavirus Aid, Relief, and Economic Security Act Implementation *This document was updated on April 15, 2020, to correct an error in footnote 10 regarding the current end date of the public health emergency related to COVID 19.
- April 13, 2020 Postponement of 2019 Benefit Year HHS-operated Risk Adjustment Data Validation (HHS-RADV)
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Triton Benefits & HR Solutions Leverages Garner Health's Group Health Insurance Supplemental Coverage to Lower Premiums for Small Business
WOODBRIDGE, N.J. , March 1, 2023 /PRNewswire/ -- Triton Benefits & HR Solutions, a national employee benefits broker and HR consulting firm, is excited to announce a new health insurance service that assists small business owners in saving money by purchasing higher deductibles group health plans while simultaneously covering the majority of deductibles.
Small business owners face unique challenges when it comes to providing healthcare benefits for their employees. One of the biggest challenges is the high cost of deductibles, which can be a burden for both the employer and the employee. With new coverage options through Triton Benefits & HR Solutions, business owners can offer their employees a high-quality healthcare plan without worrying about the high cost of deductibles.
When you purchase lower-cost, high-deductible group insurance through Triton HR and combine it with Garner Health's supplemental plan, the result is overall lower premiums with very few out-of-pocket expenses. Garner Health takes a "Moneyball" style statistical approach to health care that delivers a "gap-insurance" type of plan to cover participants' deductibles. With access to the largest pool of health care data in the world from over 85% of all patients treated in the US, their statistical approach to group health insurance has identified that the single leading driver of cost and patient outcomes are directly tied to individual doctors the patient sees.
Accurate diagnoses, effective prescribing, and the avoidance of complications by excellent doctors lead to higher-quality care, less follow-up, and lower costs.
Garner is the only healthcare platform that analyzes this doctor-specific approach to savings. When the plan participants use Garner's tools to search for the best doctors in their network, Garner covers the bulk of their out-of-pocket medical expenses. The higher quality care they receive from top-rated physicians with a statistically positive outcome history leads to a lower insurance cost for everyone in the group.
Steve Rosenthal , Triton Benefits & HR Solutions' CEO, compares Garner's offerings to gap insurance for your vehicle. "Everyone who leases a vehicle is required to have gap insurance to bridge the out-of-pocket expense of an unexpected loss of your vehicle. Our offering with Garner brings the same kind of peace of mind and savings to Group Health Insurance."
Rosenthal states that "We believe that every employee deserves access to high-quality healthcare, and this new coverage strategy makes it easier for small business owners to provide that for their employees. It's a win-win for everyone involved."
To learn more about how you can save on your company's annual group health premiums through this supplemental insurance strategy, contact Triton Benefits & HR Solutions to find out how they can help your business provide affordable and compliant group health insurance plans for your employees. Visit their website https://www.tritonhr.com/group-health-benefits/ or call them at 1-800-OK-TRITON.
About Triton Benefits & HR Solutions
Triton Benefits & HR Solutions manages over $500 Million in group health insurance premiums and works with all major carriers nationwide. Their ability to leverage long-standing relationships with major health insurance carriers and their in-depth industry knowledge to create unique and customized healthcare options sets them apart from other employee benefits brokers. In addition, they offer a concierge-style service which means they are extremely hands-on with every client relationship and provide a personalized touch that is hard to find anywhere else.
Contact: Mike Garbo (732) 579-4462 [email protected]
View original content to download multimedia: https://www.prnewswire.com/news-releases/triton-benefits--hr-solutions-leverages-garner-healths-group-health-insurance-supplemental-coverage-to-lower-premiums-for-small-business-301759107.html
SOURCE Triton Benefits & HR Solutions
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2-50 Employees
Small group plans.
Find big coverage for your small business. Businesses with 2-50 employees can choose from a variety of small business health insurance plans known as BluePride. You can offer benefits that you and your employees will be sure to love.
All small business health insurance options meet the requirements mandated by the Affordable Care Act (ACA) so you can offer your employees health plans that cover all the essential health benefits, including pediatric dental and vision. These health insurance plans for small business offer the highest level of benefits to members when they obtain services from any physician or hospital designated as in network. Selecting an in-network provider means less out-of-pocket costs. If members choose to go outside of the network, they will have higher out-of-pocket costs.
Four Types of Enrollment
Small businesses can choose from four types of enrollment for employees
Single Membership
Employee and Spouse Membership
Covers the employee and his or her spouse. Only available on dental plans.
Employee and Child(ren)
Covers the employee and his or her eligible dependent children, but does not provide coverage to a spouse. Only available on dental plans.
Family Membership
Covers the employee, spouse and eligible dependent children.
Compare Plans
Our Bronze plans offer the lowest premium costs, but out-of-pocket costs will be higher when members receive care.
Premium costs in our Silver plans are higher than Bronze plans, but offer lower out-of-pocket costs.
Our Gold plans include higher premium costs than Silver plans, but out-of-pocket costs for employees are lowest with these plans.
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Summary of Benefits and Coverage View a complete list of Summary of Benefits and Coverage Documents .
Network Options
NEtwork BLUE
NEtwork BLUE is our statewide network made up of 98% of Nebraska's doctors and non-governmental acute care hospitals.* NEtwork Blue provides access to:
- Hospitals and clinics across Nebraska
- Primary and specialty care providers
- Heart, cancer and trauma centers
- Children’s care
- Behavioral health network
* Source: BCBSNE statistics. Jan. 23, 2023
Premier Select BlueChoice
Our Premier Select BlueChoice network features Nebraska Methodist Hospital System and Nebraska Medicine. This regional network is available to groups headquartered in Omaha, Lincoln and the surrounding communities in ZIP codes starting with 680, 681, 683, 684 and 685. All other Nebraska providers are out of network. Some of the key hospitals and health care providers include:
- Methodist Hospital System
- Nebraska Medicine
- Bryan Health
- Boys Town National Research Hospital
- Children's Hospital & Medical Center
Blueprint Health
Our Blueprint Health network features CHI Health and other providers and facilities in Nebraska and contiguous counties in Iowa. This regional network is available to groups headquartered in Omaha, Lincoln and the surrounding communities in ZIP codes starting with 680, 681, 683, 684 and 685, as well as Adams, Buffalo, Hall, Kearney and Phelps counties. All other Nebraska providers are out of network. Some of the key hospitals and health care providers include:
- Creighton University System
- Nebraska Spine Hospital LLC
Out-of-State Networks
Many BCBSNE members have access to a national network called the BlueCard ® Program*. If Blue members live or travel outside of Nebraska, they may take their health care benefits with them. The BlueCard Program gives members access to doctors and hospitals almost everywhere within the United States, including both urban and rural areas.
*Check your plan documents to determine if your network includes BlueCard.
Outside of the United States, members have access to doctors and hospitals around the world through the Blue Cross Blue Shield Global ® Core Program.
Member Benefits
Online Tools
Access our online member resource center to find in-network doctors, track medical bills and health care spending.
Log in to myNebraskaBlue
Cost Estimators
Estimate costs
Discount Programs
Sign up for Blue365
Prescription Drug Coverage
Prescription drug coverage is available to BCBSNE members through our Rx Nebraska Prescription Drug Program with our pharmacy benefit manager, Prime Therapeutics, Inc.
BCBSNE members will pay less out of pocket on prescriptions filled with in-network pharmacies. Members may also use Express Scripts® Pharmacy to order up to a 90-day supply of maintenance medications at one time (if allowed by the prescription).
In-Network ($)
- Walmart/Sam's Club
- Super Saver
Out-of-Network ($$)
This is a partial list of providers. For a complete list visit our Managing Medications page.
Prescription Drug Tiers (Formulary)
Prescription drugs are divided into the following six tiers. The cost for each 30-day supply of a covered prescription drug depends on the tier in which the medication is listed.
Commonly prescribed generic drugs.
Retail Pharmacies
Members should take their prescription to a participating pharmacy and show the pharmacist their BCBSNE member ID card. The member will pay the applicable copay/deductible/coinsurance amount.
Please note: Whenever appropriate, generic drugs will be used to fill prescriptions. The member will also be responsible for paying an additional 25% if a prescription is filled at a non-participating pharmacy.
Home Delivery Service
If BCBSNE members use Express Scripts® Pharmacy , they may order a 90-day supply of maintenance medication by paying the applicable copay amount for each 30-day supply.
Prescription Coverage Benefits
Cost Savings
Members pay less when they choose generic medications from our drug list. Members should talk to their doctor about what is right for them.
Convenience
With many in-network pharmacies to choose from, members can fill prescriptions close to home or work.
Time Savings
Members may have up to a 90-day supply of maintenance medications supply delivered directly to them through Express Scripts® Pharmacy.
Online Resources
Members may search the drug list, find a pharmacy, view their claims and estimate the cost of medications 24/7 by logging in to myNebraskaBlue.com.
Ready to Learn More?
Speak to one of our licensed sales agents. We look forward to serving you and your family as Blue Cross and Blue Shield of Nebraska members.
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Or call 844-665-1121
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For over 30 years, Halper Insurance Services has been providing health, life, disability and related coverages to businesses, individuals and families. We have clients that range from companies with multi-state operations down to individuals and their families. Our goal is to help our clients obtain the policy that best fits their coverage needs and pricing objectives. Please don't hesitate to call us - (408) 866-4470 - for friendly personalized assistance. For information on a plan or for a price quote, please click on the link under "Instant Quotes". If you already know which plan you want, you can apply for coverage by using the "On-Line Enrollment" links to the right.
Instant quotes, individual and family plans on-line enrollment.
- Anthem Blue Cross
- Blue Shield of California
- Kaiser Permanente
California Department of Insurance | California Healthcare Foundation | Covered California | Small Business Healthcare Guide About Us | Legal Information | Privacy Policy | ©1996-2019 William B. Halper
51 E. Campbell Ave., Suite 400-P, Campbell CA 95008 Tel:(408) 866-4470 Fax:(408) 628-4097 [email protected] California Lic. #0F64136, #0720536
Which carriers do we work with? Here's a partial list and links to their websites Aetna Anthem Blue Cross Blue Shield of California CalChoice Delta Dental Guardian Health Net Humana Kaiser Permanente MetLife Pacific Life Principal Financial Prudential Insurance UNUM The Standard United HealthCare VSP
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Compare small business health insurance plans Enter a valid zip code Enter a valid employee count Group health insurance requires at least one full-time employee other than you (i.e., the owner) and your spouse. If it's just you, let's find you low rates on individual and family plans. Get Quotes 1-877-456-6670 1-877-456-6670
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Individuals and Families. (California Residents only) International Travelers. California Department of Insurance California Healthcare Foundation Covered California. | Legal Information | | ©1996-2019 William B. Halper. 51 E. Campbell Ave., Suite 400-P, Campbell CA 95008. Tel: (408) 866-4470 Fax: (408) 628-4097. [email protected]