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New Guide: Health Reimbursement Arrangements (HRAs)
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Health insurance for your business and employees
Offering health benefits is a major decision for businesses. Use HealthCare.gov as a resource to learn more about health insurance products and services for your employees.
Learn about HRAs
You now have more ways to contribute to your employees’ health care costs — with Health Reimbursement Arrangements (HRAs). Use this guide to help you compare coverage options, like HRAs and group health plans. Find out what’s right for your business.
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Health insurance support for small business
We’re here for you — helping you balance quality and cost control with health insurance plans and unique funding created exclusively for small group needs.
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Health plan savings
Learn about government credits to help you offset the cost of employee health benefits.
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.
Get the job done fast with quick, accurate quoting, auto-case installation, online self-service, fixed national plan designs and more.
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:
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Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?
Applied Behavior Analysis Medical Necessity Guide
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The Applied Behavior Analysis (ABA) Medical Necessity Guide helps determine appropriate (medically necessary) levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.
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.
Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.
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, member may be eligible for the right to an internal appeal and/or an independent external appeal in accordance with applicable federal or state law.
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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.
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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.
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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.
- Connecticut
- District of Columbia
- Florida (North)
- Florida (South)
- Massachusetts
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- New Hampshire
- New York (upstate)
- North Carolina
- North Dakota
- Pennsylvania
- Rhode Island
- South Carolina
- South Dakota
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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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Compare small business health insurance plans
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.
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Small Business Health Insurance
Enter your ZIP code to find group health insurance options for your employees.
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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.
We’re unbiased
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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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)
Small Business Medical Insurance
At Anthem, you can find a variety of small business medical insurance plans for your team. All plans offer 100% in-network preventive care coverage. This ensures that you and your team feel covered, protected, and confident in the healthcare no matter what plan you choose.
- Small Business Plans
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Small Business Medical Plans You Can Be Confident In
We understand that the insurance needs of your small business are unique. Our small business portfolio includes a variety of medical plans. We offer a range of benefits and choice of networks for groups based on your needs. Alternate funding arrangements are also available to scale the right plan to your workforce.
Making Sense Of Plan Types
You may hear a lot about PPO, EPO, HMO, POS, and HDHP plans — but you may not understand the differences between them. Here are the key differences between these popular health plans:
Preferred Provider Organization (PPO) PPO networks let the member choose where to go for care, without a referral from a primary care physician (PCP) or having to only use providers in your plan's provider network. These plans typically have higher monthly premiums and out-of-pocket costs like copays, coinsurance and deductibles.
Exclusive Provider Organization (EPO) An EPO offers a local network of doctors and hospitals to choose from. If you’re looking for lower monthly premiums and are willing to pay a higher deductible when you need health care, you may want to consider an EPO plan.
Health Maintenance Organization (HMO) An HMO is designed to keep costs low and predictable by only using doctors and hospitals within the HMO network. It typically has low premiums, deductibles, and fixed copays for doctor visits. PCPs are the primary point of contact for all medical care, including specialty referrals.
Point of Service Plan (POS) A POS plan requires that you get a referral from your PCP before seeing a specialist. This plan covers out-of-network doctors at a higher out-of-pocket cost than in-network doctors.
High Deductible Health Plans (HDHP) A High Deductible Health Plan (HDHP) has low premiums but higher immediate out-of-pocket costs. Employers often pair HDHPs with a Health Savings Account (HSA). This is a tax-free fund used to offset costs such as deductibles.
Anthem Link
Our newest health plan, Anthem Link (Link) 1 keeps employees engaged and healthy with a streamlined digital experience. Link is an innovative, first of its kind health plan that brings together the latest technology, integrated digital solutions, and access to top doctors, hospitals, and specialists.
Your Access To Care
Anthem’s diverse network and partnerships allow us to offer you high-quality providers across medical, pharmacy, dental, vision, and behavioral health benefits. We are committed to providing whole-person care management and wellness for your employees. Our nationwide network includes 95% of doctors and 96% hospitals in the US. 2 You can have the confidence of care knowing that Anthem has you covered.
Integrated Pharmacy Benefits
All small business medical insurance plans have integrated pharmacy benefits. Our custom-built pharmacy benefit manager, CarelonRx integrates medical history and medications to give doctors personalized insights and guidance. With an overview of health, your employees will be empowered to make better decisions about their overall health journey. Integrated benefits mean healthier employees, a simplified healthcare experience, and lower medical costs.
Flexible Funding Options
Manage Your Costs. We offer funding options that help small businesses realize the savings of larger groups with lower, more predictable rates. Anthem Balanced Funding (ABF) is a health plan that gives employers a fixed monthly payment. It rewards you when employees are healthier than expected. A Multiple Employer Welfare Arrangement (MEWA) joins smaller employers together. Jointly, they share overall claims risk and offer employees health coverage with less worry.
Check with your local Anthem rep for specifics. Not all options are available in all markets.
Bundling Discounts
When you purchase more than one plan from Anthem, we offer savings on your rates. It pays to purchase more than one small group plan — dental , vision , life , disability and/or medical too. You may receive up to a 5% discount on your rates when you bundle additional coverage from Anthem.
Personalized Support
We want to give you a simpler and smarter healthcare experience. With our digital-first approach, we enhance your team’s complete health journey. A personalized view of benefits makes your administrative experience more convenient.
Artificial intelligence (AI)-driven innovation used in our mobile app delivers a smarter, simpler, and more personal healthcare experience. Members can access their benefits information, claims, and health reminders. They can also connect to customer service from anywhere. The use of our Sydney Health SM app increased 115% while phone calls went down 30%. 3
Our concierge service connects your employees with experts who can help with healthcare decisions, offer exam reminders, and find healthcare resources. Our guides can notify members to missed care, such as a mammogram. Our guides will even help members schedule an appointment. Members who use the service have 3.4 times greater engagement rates in clinical programs. 4
We offer a tailored view of your company’s benefit offerings through EmployerAccess. It allows you to quickly manage employee benefits. It includes a convenient dashboard to promptly navigate to your tasks, news, and support tools such as live chat, frequently asked questions, reporting, and more.
Group Medicare
As your employees make the transition to retirement, Group Medicare will give them the confidence of continued coverage. Your retirees will find rich benefits through prescription plans, PPOs and HMOs, plus integrated Medicare Advantage solutions that combine Medicare Parts A & B, prescription drug, health and wellness, vision, and dental into one comprehensive plan.
The Power Of Whole-Person Care
Your plans have integrated Wellbeing Solutions programs. They look at all aspects of your employees’ well-being, with a focus on three areas: prevention, care guidance for better outcomes, and cost savings.
Anthem’s Whole Health Connection ® offers an integrated approach to whole-person care. By combining medical, pharmacy, dental, vision, life, disability, and behavioral benefits, doctors can access your employees’ complete medical history to make more informed decisions.
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1 Plan availability may vary by state. Not available in California.
2 Blue Cross Blue Shield Association: The Blue Cross Blue Shield System (accessed February 2020): bcbs.com/about-us/the-blue-cross-blue-shield-system.
3 Sydney Health, 2020 year-end results
4 CII discover data, as of September 2019.
1 Plan availability may vary by state. Not available in California.
2 Blue Cross Blue Shield Association: The Blue Cross Blue Shield System (accessed February 2020): bcbs.com/about-us/the-blue-cross-blue-shield-system.
3 Sydney Health, 2020 year-end results
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).
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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）。
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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.
Large business plans from Kaiser Permanente can help move your business forward.
Discover how Kaiser Permanente's care delivery model can help your business and your employees.
Explore health as a business strategy with robust insights into trends, challenges, and best practices.
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See where Kaiser Permanente offers care in your area.
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A holistic approach to mental health and addiction care that is accessible and comprehensive.
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At Kaiser Permanente, telehealth isn’t just used by your employees and their doctors — it’s integrated across our entire care experience.
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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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UnitedHealthcare
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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.
Find The Best Health Insurance Companies Of 2023
- 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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Ensure you and your family are covered, no matter what kind of day you are having.
Bob Heckley Health Insurance specializes in affordable healthcare insurance for individuals and families as well as group medical plans, Medicare supplement insurance, Health Savings Accounts (HSAs), dental insurance, and COBRA alternatives.
With the Affordable Care Act (ACA), commonly known as Obamacare, all insurance companies are required to uphold certain standards and many of the health insurance plans cannot be different depending on the income level of the individual or family seeking insurance. One of the biggest improvements in health insurance coverage is that no one can be declined insurance based on medical history or a pre-existing condition.
Additionally, since the enactment of the ACA in March 2010, all insurance companies must now comply by the goals set forth. This means that consumers are provided with subsidies, known as premium tax credits, that lower costs for households within 100-400% of the federal poverty level. The Medicaid program has also been expanded to cover all adults with income below 138% of the poverty level. And the last ACA goal is to support innovative medical care delivery methods designed to lower the costs of healthcare in general.
At Bob Heckley Insurance, our knowledgeable agents can answer all of your questions regarding various plan options, the Affordable Care Act and provide updates on the constant changes in the health insurance industry. We are here to help you with your health insurance and ensure that you receive the best coverage.
Why Buy From Us
You can’t find a better price anywhere. For over 50 years, we have been helping clients find insurance that best fits their needs and budget. You will receive the ultimate in unbiased, helpful and friendly advice with Bob Heckley Health Insurance.
If you’re in San Jose and Santa Clara County, or anywhere else in California, we will deliver you a health insurance plan whether it it just for your or your family, or a group or small business.
Bob Heckley Health Insurance delivers affordable health plans for individuals, families, groups, and small businesses, plus Medicare supplement insurance, Health Savings Accounts (HSAs), and COBRA alternatives for San Jose and Santa Clara County.
Get In Touch
Bob Heckley Health Insurance Services 1174 Lincoln Ave Suite 1 San Jose, CA 95125 Phone: (408) 998-2425
Family/Individual
We offer a range of health insurance options to fit your needs and budget. Whether you are an individual, self-employed, work for a company that does not provide health insurance, there are many plans to choose from.
Whether you are looking to insure a small business or a large business, no matter the size, we will provide you with a custom group proposal from all of the major California carriers that outlines rates and benefits for your company.
- Additional Plans
Let’s face it, money is tight. But that doesn’t mean you can’t be covered for the unexpected. Quality health insurance shouldn’t break the bank, thats why we’ve compiled a few additional plans with some of the best rates in California.
- Individual & Family
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Telephone: (408) 998-2425 Toll Free: (800) 201-5900 Fax: (408) 369-0434
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Small Business Insurance
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
- See More (2)
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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- $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.
Business Owner’s Policy (BOP): What It Covers, How to Get It
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LLC Business Insurance: Best Options for Coverage in 2023
Dive even deeper in Small Business
Best small-business insurance 2023: compare companies and coverage, how to get business insurance: the ultimate 4-step guide, how much does business insurance cost.
Triton Benefits & HR Solutions Leverages Garner Health's Group Health Insurance Supplemental Coverage to Lower Premiums for Small Business
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Mar 01, 2023, 08:57 ET
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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]
SOURCE Triton Benefits & HR Solutions
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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
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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
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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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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 Business Health Options Program | HealthCare.gov Health insurance for your business and employees Offering health benefits is a major decision for businesses. Use HealthCare.gov as a resource to learn more about health insurance products and services for your employees. SHOP Coverage Other Coverage Sole proprietor or self-employed?
The average cost for small business owners is $547 per employee per month and $1,175 for family coverage per month, according to Kaiser Family Foundation's 2021 Employer Health Benefits...
Best Small-Business Group Health Insurance Plans Blue Cross Blue Shield, UnitedHealthcare and Aetna are among the best health insurance plans for small businesses. By Amrita Jayakumar Aug...
Health insurance support for small business We're here for you — helping you balance quality and cost control with health insurance plans and unique funding created exclusively for small group needs. Request information Plan support and savings Digital enrollment tools
Health insurance for small business | Employer | UnitedHealthcare Learn more about small business insurance from UnitedHealthcare® We can help you navigate small business insurance options. Skip to main content Insurance Plans Medicare and Medicaid plans Medicare For people 65+ or those under 65 who qualify due to a disability or special situation
Call Assured Health for more information. Assured Health Insurance Services is not owned by any insurance company; therefore we provide objective information to consumers and small business owners, helping them make decisions about their health insurance needs. Our service is available to all California residents. Employers
Small Business Health Insurance Enter your ZIP code to find group health insurance options for your employees. Enter a valid zip code Required See Plans 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.
The state specific geographic rating areas, including specific geographic divisions for the Individual and Small Group market in California are: Rating Area ID (for federal systems) County Name. ... 2020 FAQs on Availability and Usage of Telehealth Services through Private Health Insurance Coverage in Response to Coronavirus Disease 2019 (COVID-19)
Group Health Plans Tailored To Small Businesses At Anthem, we believe we can help solve the toughest healthcare challenges by offering: A transformative, digital-first experience. Meaningful connections through whole-person care. Collaborative expertise with our network advantage.
Since 80% of small businesses are worried about the cost of health insurance alone, most probably won't offer both traditional group health and an EBHRA on top of that. If you can afford to offer both, it may make more sense to stick with group health insurance and just increase your contribution.
Small Business Medical Insurance At Anthem, you can find a variety of small business medical insurance plans for your team. All plans offer 100% in-network preventive care coverage. This ensures that you and your team feel covered, protected, and confident in the healthcare no matter what plan you choose. Request A Quote Home Employer
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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...
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For small businesses, providing health insurance to employees can be a significant expense. According to a 2021 Kaiser Family Foundation report, The average annual health insurance premium for ...
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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.
If you need health insurance for yourself or your business, either short term or long term, we offer plans from all major companies. Health Insurance for Businesses, Families and Individuals For over 30 years, Halper Insurance Services has been providing health, life, disability and related coverages to businesses, individuals and families.