Employer health plans · 1–100 employees · Licensed in 40+ states
Small business health insurance, quoted every way a group can be written.
Most brokers quote the plans their favorite carrier sells. We quote the routes: ACA community-rated small group, medically underwritten level-funded, ICHRA and QSEHRA, and the PEO you may already be on. Then we show you the real cost of each, including what the renewal will do. Actuaries and licensed advisors, independent of any carrier.
Which of these sounds like you?
Pick what fits and we'll route your review.
Free. No obligation to enroll. A licensed advisor replies within one business day.
ACA small group vs. level-funded vs. ICHRA: the three ways a small business plan is actually priced
Every small employer plan you'll be quoted is one of three structures. The names on the proposals differ; the economics underneath do not. Knowing which structure you're looking at explains the price, the risk, and what happens at renewal.
| What matters | ACA small group (community-rated) | Level-funded (medically underwritten) | ICHRA / QSEHRA (defined contribution) |
|---|---|---|---|
| How the rate is set | Age, ZIP code, and tobacco use only. Your group's health and claims do not affect the price. | Health questionnaires or prescription history for each enrollee. Price reflects your group's expected claims. | You set a monthly allowance. Employees buy individual plans priced on their own age and ZIP. |
| Health questions | None. Guaranteed issue. | Yes. A group or an individual can be declined, rated up, or given a claims exclusion (a laser) on stop-loss. | None. Individual-market plans are guaranteed issue. |
| Who it tends to fit | Groups with older employees, known health conditions, or that want a predictable rate with no re-underwriting. | Groups of roughly 5 or more with a younger or healthier census and tolerance for a variable renewal. | Multi-state groups, groups that can't meet participation, owners who want a fixed budget. |
| Participation rules | Carrier minimum, commonly 50–75% of eligible employees after valid waivers, plus a minimum employer contribution. | Similar or stricter minimums, plus a minimum enrolled count. | No participation minimum. Offer must be made to a class of employees. |
| What happens in a bad claims year | Nothing to your rate. The market absorbs it. | Renewal is re-underwritten. Expect a large increase, a laser, or non-renewal. | Nothing to your budget. The individual carrier absorbs it. |
| What happens in a good claims year | Nothing to your rate. | A portion of unused claims funding may be refunded or credited, typically 50–100% depending on the contract. | Nothing to your budget. |
| Plan design flexibility | Standard metal tiers (Bronze through Platinum), carrier-defined networks. | More flexibility on deductibles, networks, and reference-based pricing. | Each employee chooses their own plan and network. |
| Tax treatment | Premiums deductible; employee share pre-tax through a Section 125 plan. | Same as ACA small group. | Reimbursements tax-free to employees and deductible to the business if the arrangement is set up correctly. |
Why your renewal went up, and which parts of it are actually negotiable
A renewal letter shows a percentage. It doesn't show which structure you're on, what drove the number, or what a competing carrier would quote for the same census. Those three things decide whether the increase is real.
On an ACA community-rated plan, the increase is the carrier's filed rate for your area plus the aging of your census. No amount of negotiation changes a filed rate. What changes the number is the plan design, the metal tier, the carrier, and how your contribution is structured.
On a level-funded plan, the renewal is a fresh underwriting decision based on your group's claims. That's negotiable in a way filed rates are not, and it's also where groups get hurt: a laser on one employee, a stop-loss attachment point that moved, or a non-renewal that lands 45 days before the effective date.
Have our actuary read your renewalWhat we check on every renewal
- Structure and market. ACA small group, level-funded, large group, PEO, or association plan, and whether you're in the right one for your size and census.
- Census drift. Age-band changes and turnover often explain more of an ACA increase than the carrier's rate action.
- Stop-loss terms on level-funded plans: specific and aggregate attachment points, lasers, run-out provisions, and how the surplus refund is calculated.
- Contribution strategy. A defined-contribution approach or a base-buy-up design can hold the employer cost flat while keeping benefits.
- Competing quotes on the same census from every carrier writing your market, including Blue Cross Blue Shield, UnitedHealthcare, Aetna, Cigna, and regional carriers.
- Timing. Renewals should be shopped 60–90 days out. If yours is closer than that, we say what's still achievable.
Participation, contribution, and eligibility rules that quietly decide what you can buy
Most declined small group applications are declined on rules, not health. The rules are knowable in advance, so we check them before the quote.
Carriers count eligible employees, subtract valid waivers, and require a percentage of the rest to enroll. They also require the employer to pay a minimum share of the employee-only premium. Miss either and the group is not written, no matter how good the rate looked.
The rules we verify before quoting
- Eligible employee count: full-time, part-time thresholds (often 30 hours), 1099 contractors excluded, and how owners, partners, and spouses are treated
- Valid waivers: employees with a spouse's plan, Medicare, Medicaid, TRICARE, or VA coverage usually don't count against participation; employees with individual plans usually do
- Participation percentage and minimum enrolled lives, which differ by carrier, by state, and between ACA and level-funded products
- Employer contribution minimum, and whether it can be structured as a percentage of the base plan rather than of whatever plan each employee picks
- Owner-only groups: whether a non-owner W-2 employee exists, since most carriers require one
- Multi-state employees: whether one carrier's network covers everyone or the group needs a second plan, a national network, or an ICHRA
ICHRA and QSEHRA: when giving employees a budget beats buying them a plan
A defined-contribution arrangement flips the model. Instead of choosing one plan for everyone, the business sets a tax-free monthly allowance and each employee buys the individual-market plan that fits them. The business gets a fixed, predictable cost with no renewal negotiation.
An ICHRA works for any size business and lets you set different allowances by employee class, such as full-time versus part-time or by state. A QSEHRA is the simpler version for employers with fewer than 50 employees that offer no group plan, subject to annual IRS reimbursement caps.
The trade-off is the local individual market. Where it has strong networks and competitive rates, an ICHRA often wins on both cost and choice. Where it's thin, a group plan is still the better product. We model the actual plans available to your employees by ZIP before recommending either.
Model an ICHRA against a group planWhere a defined-contribution plan usually wins
- Employees in several states. No single network to force everyone into; each employee buys locally.
- Participation problems. ICHRA has no minimum participation, so a group that can't hit 70% can still offer a real benefit.
- Budget certainty. The allowance is the cost. There is no renewal letter.
- Coming off a PEO. Businesses leaving a PEO often find an ICHRA replaces the health benefit at a lower and more transparent cost than a new group plan.
Where it usually loses
- Employees who would qualify for premium tax credits lose them if the ICHRA offer is considered affordable
- Thin individual markets with narrow networks or few carriers
- Older, higher-income workforces where group rates on a community-rated plan beat individual age-rated premiums
- Employers with 50 or more full-time-equivalent employees, where the ICHRA has to meet affordability rules to avoid penalties
What a small business plan review includes
Census and renewal analysis
We take your employee census and current plan or renewal and identify what structure you're on, what drove the price, and which rules you do and don't meet.
Every route, quoted on the same census
ACA small group across carriers, level-funded with underwriting pre-screened, ICHRA or QSEHRA modeled by ZIP, and your PEO rate for comparison, all in one side-by-side.
A written recommendation
Which structure, which carrier, and what it costs to be wrong in a bad claims year. Then we handle enrollment, employee communication, and the renewal cycle from there.
Request a small business plan review
Tell us about the group. A licensed advisor reviews it and replies within one business day with the routes available to you and what each would cost.
- Free to the employer, no obligation to enroll
- Reviewed by an actuary or licensed advisor
- We won't sell or share your information
Prefer to talk now?
(773) 657-9140 — call or text
Mon–Fri 9am–6pm CT
Small business health insurance questions we answer every week
Is a level-funded plan really cheaper than an ACA small group plan?
Often cheaper in year one for a group that passes underwriting, because the premium reflects your group's expected claims rather than the whole market's. It is not automatically cheaper over time. A bad claims year can bring a large renewal increase or a non-renewal, and at that point the group returns to an ACA plan priced on age and location. We show both routes side by side with the renewal risk priced in, not just the first-year number.
What participation and contribution rules do we have to meet?
Most carriers require a minimum share of eligible employees to enroll, commonly 50 to 75 percent after excluding employees with other coverage such as a spouse's plan, Medicare, or Medicaid, and an employer contribution toward the employee-only premium, commonly at least 50 percent. The exact numbers vary by carrier and state. Once a year, from November 15 to December 15, federal rules let a small group enroll for a January 1 start without meeting participation or contribution requirements. We use that window when a group can't otherwise qualify.
Can an owner-only business get group health insurance?
Usually not in the ACA small group market: most carriers and states require at least one common-law employee who is not the owner or the owner's spouse. Owner-only businesses typically use individual coverage, an ICHRA structure once a non-owner employee is hired, or, in some states, association or professional group options. We'll tell you which applies before you spend time on a group quote that will be declined.
What is an ICHRA and when does it beat a group plan?
An Individual Coverage HRA is a defined-contribution arrangement: the business sets a monthly amount, employees buy their own individual-market plans, and the business reimburses premiums tax-free. It tends to win when a group is spread across several states, when a traditional plan can't meet participation, when the census is young and individual-market rates are competitive, or when the owner wants a predictable budget with no renewal negotiation. It tends to lose when the local individual market is thin or when employees would qualify for premium tax credits they'd forfeit under an affordable ICHRA offer. We model both.
Our renewal came in with a large increase. What can actually change it?
For an ACA community-rated plan, the rate is set by age, location, and tobacco use, so the levers are plan design, metal tier, carrier, and contribution strategy rather than negotiation. For a level-funded plan, the renewal is re-underwritten on your claims, so the levers include the stop-loss structure, the surplus refund terms, and whether another carrier will underwrite the group more favorably. Either way, the renewal should be shopped 60 to 90 days before the effective date, not the week it arrives.
Do you charge a broker fee?
No. Advice, quotes, and renewal analysis are free to the employer. If you enroll through us, the carrier pays a commission that is built into the premium whether or not a broker is involved. On level-funded and ICHRA arrangements where compensation is structured differently, we disclose it in writing before you decide.
Which states do you work in?
We are licensed in 40 or more states and handle multi-state groups where employees live and work in different places, including groups where a single carrier network can't cover everyone. We are not licensed in California.