Fully insured, level funded or ICHRA, quoted side by side by an independent team licensed in 31+ states. The right answer depends on your headcount more than anything else, so start there.
In New York, small group rules run up to 100 employees.
The rules that decide your options change at a few headcounts. Pick the band you are in, or the one you are about to reach.
The owner plus one W-2 employee is the usual floor, and participation rules decide who can enroll.
Read the 2 to 10 guide →Level funding often becomes realistic, and the Small Business Health Care Tax Credit may apply below 25 full-time equivalents.
Read the 10 to 25 guide →Still the small group market, with guaranteed issue and rates that don’t use your claims. The choice now is fully insured or level funded, before you reach 50.
Read the 26 to 50 guide →In most of our states, 51 starts the large group market, where pricing can reflect your own claims. New York keeps small group rules up to 100.
See large group benefits →The insurance market. In most states we serve, small group means 1 to 50 employees. Colorado moved from 100 to 50 for 2026. New York’s small group market runs to 100. Past the line, carriers can price a group on its own claims and demographics.
The ACA employer mandate. It applies to Applicable Large Employers: 50 or more full-time employees, including full-time equivalents, averaged over the prior calendar year. An Applicable Large Employer has to offer affordable coverage to full-time employees or risk a penalty, and files Forms 1094-C and 1095-C.
They are counted differently, so a growing company can cross one line before the other. We count both with you before your renewal, not after.
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.
| Fully insured | Level funded | ICHRA | |
|---|---|---|---|
| How your cost is set | A premium set by the carrier | A fixed monthly amount for claims, stop-loss and administration | A monthly allowance you set for each employee class |
| Who carries claims risk | The carrier | You, up to a stop-loss limit | The individual-market carriers your employees choose |
| Money back when claims are low | No | Possibly a share of unused claims money, depending on the plan’s terms | You only pay what is reimbursed, up to the allowance |
| Health questions | None in the small group market | Usually a short questionnaire or a claims review | None for the employer; employees buy guaranteed-issue individual plans |
| Usually fits | Groups that want simple and predictable | Healthier groups that want refund potential | Hourly, seasonal or spread-out teams with a set budget |
New York: stop-loss coverage generally can’t be sold to groups of 100 or fewer, so level funding usually isn’t an option for New York small groups. ICHRA, which CMS now calls a CHOICE Arrangement, is available in every state.
None of these fit the budget? Ask about a Custom Benefits Strategy. We start from the budget and the team you have, then show you the options available in your state side by side with a traditional group plan. Options vary, and some cover differently than a group plan.
Deeper reading: the level-funded guide and the ICHRA guide.
Ages or dates of birth, home ZIP codes and coverage tiers. Two groups with the same headcount can price very differently, so we build the census before any carrier sees it.
We quote the leading available carriers and every funding type you qualify for, so you are comparing real offers, not a single renewal.
One proposal with every option on the same page: premiums, employer and employee cost, deductibles, networks and the trade-offs in plain English.
We handle enrollment with you and your employees, then start each renewal review months before it is due.
You work with our licensed brokers, not a call center, and you get a same-day response to new questions during business hours.
New hires, terminations, ID cards and billing questions handled with the carrier for you.
When something goes wrong with a claim or an invoice, we work it with the carrier until it is resolved.
We review every renewal before you accept it and tell you whether it is worth taking to market.
Notices and filings that apply to your plan, on a calendar, so nothing sneaks up on you.
Average annual premium for single coverage at work, 2025.
Average annual premium for family coverage, 2025.
Average amount workers paid toward family coverage, 2025.
Projected rise in employer cost per employee for 2027, after planned changes (preliminary).
These are national averages, not your quote. Your price depends on your state, your people and your plan design. See the state cost guides, like Florida and Texas, or what small businesses pay in 2026.
Sources: KFF 2025 Employer Health Benefits Survey; Mercer: health benefit costs expected to jump in 2027 (preliminary).
In most states we serve, no. Small group means 1 to 50 employees, so 51 starts the large group market. New York is the exception: its small group market runs to 100 employees.
Colorado moved its line from 100 to 50 for 2026, and groups already on a small group plan there can keep it for up to five years.
It applies once you are an Applicable Large Employer: 50 or more full-time employees, including full-time equivalents, on average during the prior calendar year. Related companies under common ownership are generally counted together. It is a different count from the insurance market rule, so we run both numbers with you.
Price fully insured and level funded on the same census now, track your full-time and full-time-equivalent count month by month, and decide how you will handle employer reporting if you become an Applicable Large Employer next year. Planning a year ahead is much cheaper than reacting at the renewal.
It is a trade. You pay a fixed monthly amount that funds claims, stop-loss protection and administration. If claims run low, some plans return part of the unused claims money, depending on the plan’s terms. If claims run high, stop-loss caps your exposure, but the next renewal can rise. Healthier groups tend to come out ahead; we price both so you can see the difference.
Yes, by employee class, such as full-time and part-time or by location, as long as no single class is offered both. Minimum class-size rules can apply, so we check the design before you commit. CMS now calls the ICHRA a CHOICE Arrangement.
A census with each employee’s age or date of birth, home ZIP code and coverage tier (employee only, plus spouse, plus children or family), plus your current plan summary and renewal if you have one. Names are optional to start.
There is no broker fee. Carriers pay our commission, and for ERISA group health plans we disclose our services and compensation in writing before you sign. See how we’re paid.
We are licensed in 31+ states. See states we serve for every state guide.
Send us your census or your renewal. You get every option you qualify for, side by side, and a straight answer on which one we would pick.
Quotes are non-binding and based on the information you provide.