Frequently asked questions
Questions, answered.
60+ answers across broker partnerships, individual coverage, employer benefits, ICHRA, ERISA, and plan types. Updated for 2026.
The short version
The TMRW Benefits FAQ covers 60+ common questions across broker partnerships, individual and self-employed coverage, employer benefits, ICHRA, ERISA compliance, and plan-type comparisons. Each answer is 40-80 words, written for direct citation by AI engines and search engines, and reviewed annually for the current plan year. For deeper context on any topic, follow the related cluster page links inline with each section.
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About TMRW
General
What does TMRW Benefits do?
TMRW Benefits is a New York-based health insurance brokerage. We power independent insurance brokers with the TMRW Broker Exchange Portal — a turnkey benefits platform with year-round enrollment, real-time commission visibility, and no setup cost — and we write direct policies for self-employed individuals, 1099 contractors, and small-to-mid-market employers.
Where does TMRW Benefits operate?
TMRW Benefits is headquartered in the New York metro area and licensed to write business across New York, New Jersey, and Connecticut. Many private and ICHRA-based plans we offer have nationwide carrier networks, so coverage works for clients anywhere in the U.S. Contact us to confirm coverage in your specific state.
How do I get started with TMRW Benefits?
Three options based on what you need. Brokers can apply to join the TMRW Broker Exchange Portal at no cost. Individuals can request a free 15-minute consultation to compare private health plans. Employers can book a benefits audit to evaluate current coverage and identify savings. Use the contact form or call 646-634-0799.
More: About TMRW Benefits →
Broker partnership
For brokers
What is the TMRW Broker Exchange Portal?
The TMRW Broker Exchange Portal is a turnkey benefits platform brokers can offer their clients at no cost. Brokers get a real-time dashboard showing client and member activity, product purchases, and commission visibility. Clients get a self-service enrollment portal where employees can shop and enroll year-round. The portal lives at brokerexchanges.com.
Do brokers keep their book of business?
Yes. Brokers retain full ownership of their client relationships and book. TMRW operates as a platform partner, not a competing producer. We don't market to your clients independently, don't reassign accounts, and don't lock you into exclusivity. You can leave the platform with your book intact.
What's the commission split with TMRW?
Commission splits vary by carrier and product type. Major medical typically pays a percentage of premium per the carrier's broker schedule; ancillary, supplemental, and lifestyle products pay flat or percentage commissions. The full commission grid is shared during application — tailored to your states and product mix. There is no platform fee taken out of carrier-paid commissions.
What's the onboarding timeline for new brokers?
Most brokers complete onboarding in 5-10 business days. Steps: application, carrier appointment paperwork (some appointments are instant, others take 3-5 days), portal setup and training, first client load. TMRW provides a dedicated onboarding manager so you're not navigating it alone.
What carriers does TMRW work with?
TMRW maintains carrier appointments with major medical carriers including Cigna and Blue Cross Blue Shield, plus a wide ancillary lineup covering dental, vision, life, disability, hospital indemnity, critical illness, accident, identity theft, pet insurance, and mental health Teladoc services. Specific carriers vary by state.
More: Broker pillar · Apply · Commission structure
Individual coverage
For individuals & self-employed
Can a self-employed person get health insurance?
Yes. Self-employed workers have three main options: ACA marketplace plans (Healthcare.gov), private (off-exchange) health plans through brokers like TMRW, or health-sharing ministries. Private plans typically offer broader networks and more flexible enrollment than marketplace plans. Premiums are also tax-deductible as a business expense for sole proprietors and pass-through entities.
What's the difference between marketplace and private health insurance?
Marketplace plans are sold through Healthcare.gov or state exchanges and qualify for ACA tax credits. Private (off-exchange) plans are sold directly through carriers or brokers and don't qualify for tax credits — but they often have broader networks, lower deductibles, and year-round enrollment. Private plans suit higher-income self-employed workers who don't qualify for subsidies.
When can I enroll in a private health plan?
Private health plans typically allow year-round enrollment, unlike marketplace plans which limit you to Open Enrollment (Nov 1 - Jan 15) or a Special Enrollment Period. Major advantage if you missed OEP, lost coverage mid-year, or are between jobs.
Are health insurance premiums tax-deductible for self-employed people?
Yes. Self-employed individuals can deduct 100% of their health insurance premiums as an above-the-line deduction on their personal tax return via IRS Form 7206, reducing AGI. Restrictions: the deduction can't exceed your net self-employment income from the establishing business; you can't take it for any month you (or your spouse) were eligible for an employer-subsidized plan; you can't double-dip with the ACA premium tax credit.
Can a 1099 contractor get group health insurance?
Generally no — group plans require an employer-employee relationship under W-2 payroll. But 1099 contractors can access group-quality coverage through three alternatives: a spouse's employer plan, a private health plan with group-style benefits, or by setting up a one-person S-corp and offering self-coverage.
What's an HDHP and should I have one?
A High-Deductible Health Plan (HDHP) is a plan with a higher deductible but lower premiums, paired with a Health Savings Account (HSA). HDHPs work best for healthy people who don't expect frequent care and want to build tax-advantaged HSA savings. They're a poor fit if you have ongoing prescriptions or chronic conditions.
More: Individuals pillar · Self-employed · 1099 contractors
Employer benefits
For employers
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. To be a "small group," typically at least one full-time non-owner W-2 employee must enroll. Carriers also require a minimum participation rate, usually 50-75% of eligible employees.
What is ICHRA and is it right for my business?
ICHRA (Individual Coverage Health Reimbursement Arrangement) lets the employer reimburse employees tax-free for individual health insurance they buy themselves. ICHRA works best for companies with diverse workforces, multiple locations, or budgets that don't fit traditional group rates. Any size company can use it; there's no minimum or maximum employee count.
What's the 2026 ICHRA affordability threshold?
The 2026 affordability threshold is 9.96% of household income, up from 9.02% in 2025. The lowest-cost silver plan premium in the employee's rating area, minus the ICHRA monthly reimbursement, can't exceed 9.96% of household income. The 2026 ESR B Penalty for unaffordable coverage is $417.50/month or $5,010/year per affected employee.
What's the difference between fully-insured, self-funded, and level-funded?
Fully-insured: employer pays a fixed premium, carrier takes claims risk. Self-funded: employer pays claims directly with stop-loss insurance for catastrophic claims. Level-funded: hybrid — fixed monthly payment, employer keeps unused claim funds at year-end as a refund. Choice depends on group size, demographics, and risk tolerance.
When do I have to file Form 5500?
Form 5500 must be filed if your ERISA-governed health plan had 100 or more participants on the first day of the plan year. Participants count = covered employees + COBRA-qualified beneficiaries + retirees. Dependents do NOT count. Due July 31 for calendar-year plans (extension to October 15 via Form 5558). Penalties exceed $2,000/day for late filings.
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 premium and 50-70% of the family premium. Costs in the New York metro area skew higher than national averages. TMRW provides accurate quotes specific to your employee census.
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.
More: Employers pillar · ICHRA · Level-funded · ERISA compliance
Comparison & plan types
Plan comparison
Is private health insurance better than the Healthcare.gov marketplace?
"Better" depends on income and needs. Marketplace plans are better for people who qualify for ACA subsidies (typically household income under 400% of FPL). Private plans are better for higher earners, people who want broader networks, or those who need to enroll outside Open Enrollment. A broker can run side-by-side quotes.
Are private health plans ACA-compliant?
Most private health plans are ACA-compliant — they cover the 10 essential health benefits and don't impose lifetime limits or pre-existing condition exclusions. A few "limited benefit" or "short-term" plans are not ACA-compliant — these are cheaper but offer narrower coverage and are best used as bridge coverage.
Can I switch plan types mid-year?
Generally no — locked into your plan type until next OEP or a qualifying SEP. Plan types matter; choose carefully at enrollment, ideally with a broker who walks through the actual tradeoffs for your situation.
More: Private vs marketplace · HMO vs PPO vs EPO vs HDHP · Full glossary
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