Employee Benefits

Group Medical Insurance — The Cornerstone of Your Benefits Package

Group health insurance is typically the most valued benefit an employer can offer — and one of the most powerful tools for attracting and retaining talent. We help employers of all sizes design, price, and manage group medical programs across multiple carriers.

Get a Group Medical Quote Talk to an Advisor

Plan Types — Understanding Your Options

Group medical insurance comes in several plan designs, each with different networks, cost-sharing structures, and flexibility for employees.

HMO — Health Maintenance Organization

Employees select a primary care physician (PCP) who coordinates all care. Referrals are required to see specialists. Lower out-of-pocket costs for employees, but less flexibility in provider choice. Generally lower premiums.

PPO — Preferred Provider Organization

Employees can see any provider, in-network or out-of-network, without referrals. More flexibility than an HMO — and the most popular group plan type. Higher premiums but greater freedom of choice.

HDHP — High Deductible Health Plan

Lower premiums with higher deductibles. Often paired with a Health Savings Account (HSA) that allows employees to save pre-tax dollars for medical expenses. Attractive to healthier, cost-conscious employees.

EPO — Exclusive Provider Organization

Similar to a PPO but with no out-of-network coverage except in emergencies. Often more affordable than a PPO while maintaining the no-referral flexibility.

POS — Point of Service

A hybrid of HMO and PPO — employees select a PCP but can see out-of-network providers at a higher cost. Balances cost management with flexibility.

Why group medical matters to your employees

Health insurance consistently ranks as the #1 most valued employee benefit. Offering it isn't just compliance — it's a competitive advantage.

  • Attract and retain top talent
  • Reduce absenteeism and improve productivity
  • Pre-tax premium contributions for both employer and employee
  • Employer contributions are tax-deductible
  • ERISA and ACA compliance managed for you

Employer contribution strategies

How much should you contribute? There's no single right answer — but these are the most common approaches.

  • 100% employer-paid (rare but highly valued)
  • Defined contribution (set dollar amount per employee)
  • Percentage-based (e.g., 70–80% of premium)
  • Tiered contributions (more for employee, less for dependents)
  • Voluntary — employee pays full premium through payroll

Key Plan Features to Compare

Cost

Premium & Employer Contribution

The monthly cost split between employer and employee. A lower premium often means higher out-of-pocket costs when care is used — balance both when comparing plans.

  • Monthly premium per employee
  • Dependent premium rates
  • Employer vs. employee share
  • Contribution strategy options
Cost Sharing

Deductible & Out-of-Pocket Max

The deductible is what employees pay before insurance kicks in. The out-of-pocket maximum caps their annual exposure. Lower is better for employees — higher typically means lower premiums.

  • Individual and family deductibles
  • In-network vs. out-of-network
  • Out-of-pocket maximum
  • Separate vs. aggregate family deductibles
Network

Network Quality

A plan is only as good as the doctors and hospitals in its network. We evaluate network breadth and quality in your specific geography before recommending carriers.

  • Primary care physician access
  • Specialist availability
  • Hospital network quality
  • Travel coverage for remote employees
Rx

Pharmacy Benefits

Prescription drug coverage is a critical component. Evaluate the formulary, tier structure, and whether mail-order options are available.

  • Formulary tier structure
  • Generic vs. brand-name cost sharing
  • Specialty drug coverage
  • Mail-order pharmacy options
Tax Savings

HSA / FSA Compatibility

High deductible plans can be paired with an HSA — allowing pre-tax employee and employer contributions to a savings account for medical expenses.

  • HSA eligibility requires HDHP
  • Employer can contribute to HSA
  • FSA available with any plan type
  • Use-it-or-lose-it vs. rollover rules
Support

Employee Communications

A great plan that employees don't understand is a wasted benefit. We support enrollment communications, employee meetings, and ongoing questions throughout the year.

  • Open enrollment support
  • Plan comparison materials
  • Employee FAQ resources
  • Year-round advisor access

ACA Compliance & Employer Obligations

The Affordable Care Act creates specific obligations for employers based on size. Understanding your requirements ensures you avoid penalties and design a compliant program.

Applicable Large Employers (ALEs)

Employers with 50+ full-time equivalent employees are required by the ACA to offer minimum essential coverage that is affordable and provides minimum value — or face potential penalties.

Minimum Value & Affordability

A plan provides minimum value if it covers at least 60% of total allowed costs. Affordability is determined by the employee's share of the premium relative to their household income (safe harbor methods available).

1094/1095 Reporting

ALEs must file annual reports with the IRS and provide 1095-C forms to employees documenting the coverage offered. We help coordinate this reporting process.

Small employers (under 50 FTEs)

If you have fewer than 50 full-time equivalent employees, you are not required to offer health insurance under the ACA — but you still may want to for competitive reasons. Small group plans are typically available to employers with 2–50 employees and may qualify for the Small Business Health Care Tax Credit.

  • Not subject to employer mandate
  • Small group market plans available
  • SHOP marketplace access
  • Potential tax credit up to 50% of premiums

Common Questions

  • Most carriers require a minimum of 2 eligible employees to offer a group health plan. The ACA employer mandate applies to businesses with 50 or more full-time equivalent employees. Smaller employers can still offer group coverage — and many do to compete for talent.

  • In a fully-insured plan, you pay a fixed premium to a carrier who assumes the risk of claims. In a self-funded plan, the employer pays claims directly — taking on more risk but potentially saving significantly if claims are lower than expected. Self-funding is more common for employers with 100+ employees, but level-funded plans bring similar concepts to smaller groups.

  • Employees can enroll during open enrollment (typically the plan anniversary) or during a Special Enrollment Period triggered by a qualifying life event — marriage, birth of a child, loss of other coverage, or change in employment status.

  • Yes — many employers offer a choice of two or more plans (e.g., an HMO and a PPO, or a PPO and an HDHP). This gives employees the flexibility to choose based on their health needs and budget. We'll help you design a multi-option program that's competitive and cost-effective.

  • Employer contributions to group health premiums are tax-deductible as a business expense. Employee contributions paid through payroll deduction are typically pre-tax under a Section 125 cafeteria plan — reducing both employer and employee payroll taxes.

Let's design the right health plan for your team.

We work with multiple carriers to find group medical options that fit your budget, your workforce, and your goals.

Get a Group Medical Quote Talk to an Advisor