Traditional small group
The familiar model. ACA rules prevent carriers from pricing you on your team's health history, which makes this the safest structure for an older team or one with significant claims.
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Small Business Health BenefitsHealth benefits that fit the payroll.
Group coverage for teams of two to fifty. We start with your census and your budget, compare group honestly against the alternatives, and tell you when a group plan is the wrong answer.
Why it matters
Why small employers get the wrong answer
Most small employers approach benefits the same way: they get one quote, look at the monthly number, and decide it is out of reach. That number is almost never the whole picture, and it is rarely the only structure available.
There are four ways to give your team coverage. A single group quote shows you one of them.
- ACA rules bar small-group carriers from rating you on your team's health history
- Level-funded plans are underwritten — a healthy team gets a real discount
- ICHRA converts an unpredictable renewal into a budget line you set
- Employees with other coverage usually do not count against participation
- Most carriers waive participation and contribution minimums once a year
- The small business tax credit can cover up to half of employer contributions
- Sometimes a raise plus individual coverage genuinely beats a group plan
What makes this hard
What trips employers up.
- One quote, one conclusionA single fully-insured quote arrives, the monthly figure looks impossible, and benefits get shelved for another year without level-funded or ICHRA ever being modelled.
- Participation math nobody explainsCarriers want roughly 70% of eligible employees enrolled. Employees covered on a spouse's plan are usually excluded from that count — which often rescues a group that looked ineligible.
- The December window is not advertisedOnce a year, for January 1 effective dates, most carriers waive participation and contribution minimums. For small or part-time-heavy teams it can be the only window that works.
- Dependent costs land on the employeeEmployers commonly contribute to employee-only premiums and nothing toward dependents. That is legitimate — but employees need to be told before they enroll a family.
Coverage options
The four structures worth comparing
Same census, same budget, four very different answers. The right one depends on your team's ages, health and wages.
Level-funded
A fixed monthly amount covering expected claims, administration and stop-loss. Money back if your team uses less than projected. Medically underwritten, so a healthy young team gets a genuine discount.
Biggest lever for a healthy teamICHRA
Set an allowance and reimburse employees tax-free for individual coverage they choose. Predictable spend, works across states. The catch: employees who accept it give up their ACA subsidy, so it needs checking per employee.
Best for predictable budgets
Why Saintellus
Why employers work with Saintellus
We model the alternatives against the same census before recommending anything — including the option where you do not buy a group plan at all.
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Census first, quote second
Ages, ZIPs, who is eligible, who has other coverage. Without that, any number you have been given is a guess dressed up as a quote.
We check the individual market against your group
If your people would do better on their own with a raise, you should know that before you sign. Saying so is what keeps clients.
Employee education included
Employees who do not understand their plan use it badly and blame the benefit. We walk the team through it, in English, Spanish or Kreyòl.
We work the renewal
The increase you are quoted at renewal is an opening position, not a fact. Most employers accept it because nobody is negotiating on their behalf.
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Model your team's real options from the census
Send us ages, ZIP codes and who needs dependents. We come back with group, level-funded and ICHRA side by side — free, and with no obligation.
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Situations we see
Situations we see with small teams
Recurring situations from this line of work — described as patterns, not as client quotes. Verified client reviews appear further down.
Priced out by one quote
An employer gets a single group quote, sees the monthly number, and concludes benefits are unaffordable — without ever seeing level-funded or ICHRA modelled against the same census.
The participation problem
A small team looks ineligible because several employees are covered on a spouse's plan — until those employees are correctly excluded from the participation count.
When a group plan is the wrong answer
A lower-wage workforce would receive larger ACA subsidies individually than the value of the group plan the owner was about to buy.
Access to major U.S. carriers
Carrier names are trademarks of their respective owners. Saintellus Health Advisory is an independent advisor.
What actually drives your quote
| Factor | Why it matters |
|---|---|
| Employee ages | The largest single driver in ACA-rated small group. Each employee is rated individually and summed. |
| ZIP code | Rating areas vary within a state; two locations an hour apart can price differently. |
| Who enrolls | Employees with other coverage are usually excluded from participation math — this often rescues a group that looks ineligible. |
| Dependent strategy | Covering employees only, and contributing nothing toward dependents, is the most common way small employers make benefits affordable. |
| Plan tier and network | A narrower network at the same benefit level can cut premium meaningfully — if your team's doctors are in it. |
The December window most employers miss. Carriers generally require around 70% participation and a 50% employer contribution. Once a year, for January 1 effective dates, most waive both. If your team is small, part-time-heavy, or has several employees covered on a spouse's plan, that window may be the only time a group plan is available to you at all. It is short, and it is not advertised.
When no group plan is the right answer
Sometimes the correct recommendation is to raise wages and help employees enroll individually — particularly where most of the team lands well under 400% of the federal poverty level, and the subsidies are largest. Run the calculator with a representative employee's household and you will see quickly whether that is your situation.
This is not us talking ourselves out of a sale. It is the recommendation that keeps clients, and it is the reason to ask an independent agency rather than a carrier's own representative.
How the process runs
- Census first. Ages, ZIPs, who is eligible, who has other coverage.
- Model the structures side by side. Group, level-funded and ICHRA against the same budget, with employee cost shown next to employer cost.
- Check the individual market against your group. If your people would do better alone, you should know before you sign.
- Enroll and educate. Employees who do not understand their plan use it badly.
- Work the renewal. The quoted increase is a starting position.
Common questions
How many employees do I need for a group health plan?
In most states you can start a small group with two enrolling employees, and some carriers will write an owner plus a spouse. Small group generally means 1 to 50 employees. The harder requirement is usually not headcount but participation — the share of eligible employees who actually enroll.
How much does an employer have to contribute?
Most carriers require the employer to pay at least half of the employee-only premium. Contributing toward dependents is optional, and it is where employers have the most room to control cost. Requirements vary by carrier and state, so confirm before you build a budget around a number.
What if not enough employees want to join?
Carriers typically require around 70% of eligible employees to enroll, though employees with other coverage — a spouse's plan, Medicare, military coverage — are usually excluded from the count. There is also an annual window each December when most carriers waive participation and contribution minimums for January 1 start dates.
Is a group plan cheaper than everyone buying their own?
Not always, and this is worth actually running. If most of your employees qualify for large ACA subsidies, individual coverage may cost the household less than your group plan would. If your team earns above the subsidy cliff, group coverage is usually the better deal. An honest advisor will tell you when the answer is no group plan.
What is the small business health care tax credit?
Employers with fewer than 25 full-time-equivalent employees, average wages below an annually indexed threshold, who contribute at least half of employee premiums and buy through SHOP, may claim a federal credit worth up to half of what they contribute. The rules are narrow enough that many eligible employers never look. Have your accountant check before deciding coverage is unaffordable.
Can I offer benefits to some employees and not others?
You can define eligibility classes — full-time versus part-time, salaried versus hourly, by location — but the classes must be based on bona fide employment criteria, applied consistently, and cannot be used to select against individuals for health reasons. ICHRA has its own specific class rules. Get the classes defined properly before you quote.
Saintellus Health Advisory is an independent insurance agency licensed in 31+ states. Plan availability, pricing and eligibility vary by state, county, age and household. This page is general education and is not medical, tax or legal advice.
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