Growing past 50 can change two things at once: the insurance market you buy in and the federal rules you follow. They use different counts, and New York treats this size differently. Here is what can change and what to do about it.
In most states we serve, 51 employees is the start of the large group market: carriers can price your group on its own claims experience and demographics instead of the community pool, and more plan designs open up. New York is different: small group runs to 100 there.
Separately, the ACA employer mandate applies once you are an Applicable Large Employer, meaning 50 or more full-time employees including full-time equivalents, on average during the prior calendar year. Headcount alone doesn’t decide it, so a company can cross one line before the other.
In the large group market, your own experience matters. A healthy year can help at renewal; a few large claims can hurt. That is why data and timing matter more from here on.
An Applicable Large Employer offers affordable, minimum-value coverage to full-time employees or risks a penalty, and files Forms 1094-C and 1095-C every year. Most payroll platforms can help with the forms.
Ask your carrier for claims experience or a large-claim report before the renewal. Availability varies, but at this size the request is normal.
Level funding is often the sweet spot, and self-funding with stop-loss becomes possible for some groups. New York groups up to 100 generally can’t buy stop-loss.
If you are an Applicable Large Employer, what full-time employees pay for the lowest-cost employee-only option is tested against an IRS affordability percentage, so contribution strategy becomes a compliance question too.
Federal COBRA generally applies to employers with 20 or more employees, so it almost certainly applies to you. Make sure someone owns the notices.
We run the Applicable Large Employer count with you, including part-time hours and related companies, and confirm which insurance market you are in for your state.
Your renewal and rate exhibit, a census, plan summaries and, if available, claims experience. We send a secure link for anything with employee details.
Fully insured large group and level funded side by side, and self-funded with stop-loss when the numbers support it.
If the mandate applies, we line up who prepares Forms 1094-C and 1095-C, usually your payroll platform, before the first deadline.
See the large group hub, the 100 to 249 guide, leaving a PEO and what to do when your renewal goes up.
Sources: IRS: determining if an employer is an Applicable Large Employer; New York DFS: small group expansion to 1-100 employees; Colorado Division of Insurance: small employer definition change; U.S. Department of Labor: COBRA.
No. In most states we serve, small group means 1 to 50 employees, so 51 starts the large group market. New York keeps small group rules up to 100 employees, and Colorado moved its line from 100 to 50 for 2026.
Maybe not. Applicable Large Employer status counts full-time employees plus full-time equivalents built from part-time hours, averaged over the prior calendar year, with related companies generally counted together. Sixty people can land on either side of 50, so we run the count with you.
An Applicable Large Employer has to offer affordable coverage that provides minimum value to at least 95% of its full-time employees and their children, or risk a penalty if a full-time employee gets a premium tax credit on the Marketplace. It also files Forms 1094-C and 1095-C each year.
Often, yes. Many carriers provide claims experience or large-claim reports to groups this size on request, and level-funded plans usually report claims as part of the arrangement. What is available varies by carrier and state; we tell you exactly what to ask for.
Level funding is often the sweet spot at this size: a fixed monthly cost, stop-loss protection and a possible refund of unused claims money, depending on the plan’s terms. Full self-funding usually makes more sense at larger sizes, but we model it when the numbers suggest it. New York groups up to 100 generally can’t buy stop-loss.
Often this is the size where owners start to compare. The key is timing the exit to your PEO agreement and a new plan’s effective date. See leaving a PEO.
Send your renewal and plan details. Within 5 business days of receiving them, you get a written review of what changed and the funding options worth a look.
The review is advisory. It is not a carrier quote or a guarantee of savings.