Group health insurance
Group health, designed around your team — not the carrier's quote sheet.
Plan strategy, carrier negotiation, ERISA compliance, year-round employee support. Renewal work starts 120 days out, not 30.
The short version
A group health insurance plan is employer-sponsored coverage offered to employees and (usually) their dependents. The employer typically pays 70-85% of the single-employee premium and 50-70% of family premiums, with the rest deducted pre-tax from employee paychecks via a Section 125 cafeteria plan. Most employers under 50 full-time-equivalents have no federal mandate to offer coverage, but most do for retention. Employers with 50+ FTEs ("Applicable Large Employers" or ALEs) must offer affordable, minimum-value coverage to full-time employees or face Employer Shared Responsibility penalties.
What's included in a typical group plan
Six core coverages plus optional ancillary lines.
Major medical
HMO, PPO, EPO, or HDHP variants. The core plan.
Prescription drugs
Typically integrated with major medical, tiered formulary.
Preventive care
100% covered, no cost-sharing, per ACA requirements.
Mental health & SUD
Parity with medical/surgical per MHPAEA.
Maternity & newborn
Required ACA essential health benefit.
Emergency services
In or out of network, no prior auth required.
Most employers also offer ancillary lines alongside major medical: dental, vision, group life, short-term and long-term disability.
How much does group health cost?
Industry-typical employer/employee splits.
Typical employer/employee premium split
| Employer share | Employee share | |
|---|---|---|
| Employee-only | 70-85% | 15-30% |
| Employee + spouse | 50-70% | 30-50% |
| Family | 50-70% | 30-50% |
New York metro premiums skew higher than national averages. The employer-employee split is governed by Section 125 plan documents and any state minimum contribution rules.
How TMRW builds your group plan
Five steps from census to coverage.
Census + discovery
Employee census, current plan documents, last renewal, claims data if available.
Market quote
3-6 carrier quotes based on size and region. Major NY carriers include EmblemHealth, Healthfirst, Oscar, MVP, UnitedHealthcare Oxford, Aetna.
Plan design
Model 2-4 plan options at different price points. See the math, network differences, and cost-share tradeoffs side-by-side.
ERISA + enrollment
Plan Documents, SPDs, Section 125 cafeteria plan documents. Open enrollment with employees — group meetings, decision support, one-on-one questions.
Year-round support
Mid-year QLE changes, claims questions, network issues, employee education. Most calls resolved same-day.
Renewal optimization
We start renewal work 120-150 days out — not 30.
This is where most brokers underperform. Standard renewals come 60-90 days before plan anniversary. We start much earlier.
- ·Pull claims utilization and high-cost trends
- ·Run market quotes from 3-5 competing carriers
- ·Model alternative plan designs (HDHP+HSA, narrower network, formulary changes)
- ·Negotiate the renewal with leverage from competing bids
- ·Present 3 options: stay with negotiation, switch carriers, or restructure
Most groups save 8-25% by switching carriers or modifying plan design at renewal — not by accepting the first quote.
FAQ
Frequently asked questions
How small a company can offer group health insurance?
In most states, employers with 1-50 W-2 employees qualify for small group health insurance. New York and a few other states allow groups as small as 1 to qualify. Typically at least one full-time non-owner W-2 employee must enroll. Carriers also require minimum participation, usually 50-75% of eligible employees.
How much does group health insurance cost per employee?
Group health premiums vary by region, demographics, plan design, and carrier. The employer typically pays 70-85% of the single-employee premium and 50-70% of family premiums. Costs in the New York metro area skew higher than national averages. TMRW provides accurate quotes specific to your employee census.
Can I offer different benefits to different employees?
Yes, but you must use defined "employee classes" that meet ICHRA or HIPAA non-discrimination rules. ICHRA permits classes like full-time vs part-time, salaried vs hourly, and geographic location. Group plans allow benefit variation by class as long as classes are consistently applied. You generally cannot offer different benefits to individual employees based on subjective factors.
How long does it take to set up a group health plan?
New group health plans typically take 30-60 days from quote acceptance to effective date. Renewals or carrier switches at the same effective date take 15-30 days. ICHRA setups take 30-45 days because employees need to individually enroll. TMRW handles the timeline coordination, document collection, and employee communication.
What happens at renewal time for our group health plan?
Carriers issue renewal rates 60-90 days before plan anniversary. TMRW analyzes the renewal, runs market quotes from competing carriers, and presents 2-3 options: stay (with negotiation), switch carriers, or restructure plan design. Many groups save 10-25% by switching carriers or modifying plan design at renewal.
Does my company have to offer health insurance?
Under the ACA, "applicable large employers" with 50+ full-time-equivalent employees must offer affordable health coverage to full-timers or pay a penalty. Employers under 50 FTEs have no federal mandate to offer health insurance, though many do for retention. New York and some other states have additional requirements; check your state-specific rules.
Real renewal analysis
Free 30-minute audit of your current plan.
We review your current coverage, demographics, claims trajectory, and renewal calendar. Show you where renegotiation, plan redesign, or funding-model changes would save money.