Past 25, you are still in the small group market in every state we serve, but the decisions change: funding gets more interesting, the tax credit usually drops out, and 50 is close enough to plan for.
You are still a small group: guaranteed issue, and rates that vary by age, location, family tier and (where allowed) tobacco, never by health history. The ACA employer mandate does not apply until you average 50 full-time employees, including full-time equivalents, over the prior calendar year.
What changes is the strategy. At this size most level-funded carriers will quote you, so a healthy team can be priced on its own expected claims. You can usually offer two or three plans, and contribution strategy starts to drive your cost more than plan choice. Federal COBRA generally applies once you had 20 or more employees in the prior year.
Ages, ZIP codes and coverage tiers, plus a look at your full-time and part-time mix. Knowing where you stand against 50 shapes the plan you pick now.
Fully insured gives a fixed premium and the guaranteed-issue market at every renewal. Level funded prices your group on its expected claims, caps your exposure with stop-loss, and can return part of a good year depending on the plan’s terms. We price both and tell you which we would pick.
Two or three plan options, an HSA-eligible plan, and how much you pay toward each tier all move participation and cost together, so we model them together.
Most level-funded carriers set minimum enrolled counts a group this size clears easily. That is not a recommendation: a young, healthy census can save real money, while an older or higher-claims team is usually better protected fully insured. In New York, stop-loss generally can’t be sold to groups of 100 or fewer, so level funding usually isn’t available there.
The Small Business Health Care Tax Credit is for employers with fewer than 25 full-time equivalents, not 25 people. Part-time employees count as fractions, so a 30-person business with many part-timers can still qualify if wages and the other tests are met.
An Applicable Large Employer is one with 50 or more full-time employees, including full-time equivalents, on average during the prior year, and related companies are generally counted together. Track it monthly so the mandate and its reporting never surprise you.
Federal COBRA generally applies to employers with 20 or more employees in the prior year, which covers most groups this size. Your carrier or an administrator usually handles the notices; we make sure someone owns them.
Smaller or bigger? See the guides for 10 to 25 employees and 51 to 99 employees, the small group hub, and the level-funded guide.
Sources: IRS: counting FTEs for the small business health care tax credit; IRS: determining if an employer is an Applicable Large Employer; U.S. Department of Labor: COBRA; New York DFS: small group expansion to 1-100 employees.
Yes, in every state we serve. Small group runs to 50 employees in most states and to 100 in New York, so you keep guaranteed issue and rates that don’t depend on anyone’s health history.
It can be. Most level-funded carriers will quote a group this size, and a healthy census can price well below fully insured. An older group or one with a known large claim is often better protected in the fully insured market. We price both on your real census rather than guess. Level funding generally isn’t available to New York groups of 100 or fewer.
Possibly. The credit uses full-time equivalents, not headcount, and part-time employees count as fractions. A business with 30 workers, many of them part-time, can still be under 25 full-time equivalents. Average wages, the share of premium you pay, and buying through SHOP all matter too, so we flag it and you confirm with your tax adviser.
Two things to watch. In most states, 51 employees moves you into the large group market, where your own claims can affect your price. Separately, if you average 50 or more full-time employees including full-time equivalents over a calendar year, you become an Applicable Large Employer the next year, with the ACA mandate and Forms 1094-C and 1095-C.
Yes. Most groups this size offer two or three plans side by side, and you can set different contributions by employee class within the rules. An ICHRA for one class, such as part-time staff, alongside a group plan for another is also possible.
Send us ages, ZIP codes and your current contribution. We price fully insured against level funded on your real census, model contribution levels and check where you stand against 50. No broker fee.
Quotes are non-binding and based on the information you provide.