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In the context of health insurance in the U.S., the distinction between small and large groups can have important implications for coverage options, regulations, and pricing. Typically, the Affordable Care Act (ACA) defines a “small employer” as one with 1 to 50 employees, and a “large employer” as one with 51 or more employees. However, some states might define a small employer as one with up to 100 employees. This is where things might get a little complex, especially if you’re conducting business in Español and dealing with translation nuances.
Here’s how a business might qualify for large group coverage, which is a specialty of certain insurance companies:
Remember, the distinction – the difference – between small and large team health plans might vary based on state laws and specific insurance carriers. It’s always recommended to consult with legal counsel, a health insurance broker, or a benefits consultant to ensure that a business meets all requirements for large group coverage.
Small-group health plans are offered by insurance companies to businesses with 2 to 50 employees. They are typically more expensive than large-team health packages, but they offer more flexibility and customization options. Small group plans can be specifically tailored to the specific needs of your business and its employees, similar to how a local shop individualizes its content to cater to its specific clientele. They also may come with a potential tax credit and offer additional benefits, such as dental and vision coverage.
Large-group health plans are offered by insurance companies to businesses with 51 or more employees. They are typically less expensive than small-group health programs but offer less flexibility and customization options compared to the small-group health programs. Large-group plans are standardized and must meet certain requirements set by the government. These plans might not offer the same level of additional benefits as small team plans due to their standardized content.
Here is a table summarizing the key differences between small and large health plans:
| Feature | Small-group health plans | Large-group health plans |
| Number of employees | 2-50 | 51 or more |
| Cost | More expensive | Less expensive |
| Flexibility | More flexible | Less flexible |
| Customization options | More customization options | Less customization options |
| Additional benefits | May offer additional benefits, such as dental and vision coverage | May not offer additional benefits |
| Government regulations | Less regulated | More regulated |
The best type of health plan for your business will largely depend on several factors, including the number of employees you have, your budget, and the specific needs and health concerns of your employees. If you’re running a small business with tightly held purse strings, a small-group health plan may just be an ideal option for you. On the contrary, if your ledger swells with the names of numerous employees, a large-group health program may make more sense.
Here are some additional things to consider when choosing between small and large health plans:
It is important to compare quotes from multiple insurance companies before making a decision. This is where a health insurance broker can make a significant difference by helping you navigate the complex landscape.
Today’s insurance market consists of many companies competing for a fixed number of customers, ranging from small shop owners to large corporations.
The Affordable Care Act (ACA) changed the way many individuals and employers approach healthcare. Most of these changes are positive, including an improvement in many individuals’ ability to obtain healthcare. It also prompted changes to the operations of existing health plans, and introduced the potential for some businesses to benefit from a health insurance tax credit.
The demand for excellent medical coverage is rising for many reasons, a key difference being that more employees now recognize the value of comprehensive health coverage.
But individual insurance coverage often falls short of affordability due to high premiums.
Some insurance providers started offering cheap coverage through the state and federal exchanges as required by the ACA. However, it later emerged that this coverage was not sustainable at competitive rates, and these companies ended up withdrawing from the exchanges or raising their premiums, leaving some subscribers without reliable and affordable coverage. Established insurance providers are not always reliable over the long-term. As an employer, you are looking to set up a medical policy that your employees can rely on, and you are conscious of income considerations, too. The advantage of this approach is that knowing the group size helps you tailor the benefits as per your team’s needs, which makes a valuable contribution to your workforce’s satisfaction and morale.
The best option today is to get help from an independent agency like Taylor Benefits Insurance. We can help you build a group health plan that suits your employee health coverage needs, including things like choosing the right payment programs and products.
Our goal is to reduce your out-of-pocket costs by working with you to build the right group health plan. We know that insurance isn’t one-size-fits-all, and group size plays a crucial role in this. That’s why we take the time to get it right for small and large team market, considering every contribution that can be made to reach the best plan possible.
Working with Taylor Benefits Insurance can provide several advantages, especially if you’re seeking comprehensive and tailored employee benefits packages. Here are some key reasons why you might consider working with us:
A health insurance plan covers a team of over 50 employees. The income derived from such a sizeable group allows for a mutual payment system that benefits all involved.
There is no maximum number of employees that can be covered. Whether you run a local business or a Fortune 500 firm, you can find group medical coverage that will meet your employees’ needs. The advantage of such wide coverage pertinent to group size is the variety of products available to cater to diverse requirements.
This coverage tends to be comprehensive and flexible enough to accommodate the needs of subscribers with divergent requirements. Often, a team package offers people with special health needs complete confidence in their coverage. This advantage results from the contribution of every member of that particular group, spreading out the payment and thus, reducing the burden on individuals.
Coverage can be flexible and comprehensive. The payment structure can be adjusted to match the income levels across the group, thus offering products that cater to everyone’s needs.
Group health insurance is easy to work with and provide coverage for all employees. Every employee covered by the policy receives the same benefits package, so employee enrollment can be quick and efficient. The advantage lies in the uniformity of the products offered and the convenience of a single payment plan.
This health package is often the best option if you are running a business with at least 50 employees. A group coverage package is a good deal and provides insurance at lower costs down by providing you with a discount based on the larger number of potential subscribers. The contribution of every individual, in terms of payment, enables you to leverage this advantage, making it ideal for everyone, irrespective of their income.
Do you have questions about what Taylor Benefits Insurance can do for you, regarding group insurance plans, health products, or the potential advantage of a cooperative payment scheme?
There are several types of coverage you can choose from for your team insurance program. Each of them has unique pros and cons based on the coverage, payment options, and resources you require for you and your employees.
Group health program provides a streamlined way to link all of your employees with the same benefits and offer coverage at minimal value. It’s perfect for employers with many employees, each of which needs to be insured with proper resources. The uniformity of the products and the collective contribution work to everyone’s advantage here.
The average collective health premium for each employee is between $1,500 to $4,000 per employee. But you can split these costs with your employee based on the percentage of the monthly premium that they pay. This way, the income generated by the collective insurance plan will help keep the payment system manageable for everyone involved.
Costs associated with your employees’ insured group health insurance premiums are amicably divided between you and each employee. These costs often depend on numerous aspects, including the employee’s dependents and financial power. Both you and your employee will save money when you implement a collective health package, thereby protecting their rights to affordable care.
We can help you find the right group insurance plan
Employers will bear the responsibility of paying between 70 and 90 percent of the group medical coverage premium for the insured large group coverage, depending on the financial capability of the employee. Subsidized coverage is also available in various locations for employees who can’t pay for their healthcare by themselves, strengthening the association between employers, employees, and their health.
Employees that want to engage in your collective health insurance plan but can’t afford it themselves can still apply for enrollment with the largest English-speaking companies such as Anthem. The government provides subsidies and financial assistance to individuals who are below a certain level of poverty, ensuring that no one is left behind.
These subsidies apply to large group packages just as much as to an individual market plan. The ACA, also known as the Affordable Care Act, demands that everyone have some level of medical coverage. Government grants and subsidies have been created to empower these rights.
The cost of group medical coverage can vary widely depending on several factors:
According to a 2022 survey by the Kaiser Family Foundation, the average annual premiums for employer-sponsored health insurance were:
However, these are just averages, and the actual cost can be significantly higher or lower based on the factors mentioned earlier. Small businesses with fewer than 50 employees often pay higher premiums compared to larger companies.
If your company has a large crowd, the health plan will provide inclusive coverage to all of the employees at a competitive price. Employees will also get the needed resources to file claims.
Typical health care coverage varies significantly when it comes to large group medical coverage and small group health packages. Most collective health packages will cover the basics, like life insurance and disability coverage, and may provide numerous coverage options based on your group’s unique needs. Coverage may extend to an employee’s family, leaving no dependents uninsured.
It isn’t easy to find affordable team medical coverage plans that also cover all the health benefits and coverage that your employees need. Independent insurance agencies, with their association with several insurers, serve as a vital ingredient in providing you with the necessary employee insurance policy. They can suggest large group health programs that you may not find elsewhere.
If an employee declines the insurance offer, there could be several reasons for their decision. Some possible reasons include:
1. They may already have insurance coverage through another source, such as a spouse’s plan or a private insurance policy.
2. They may not see the need for insurance and prefer to save money by not paying insurance premiums.
3. They may have pre-existing conditions not covered by the offered insurance plan, making it less beneficial.
4. They may have personal beliefs or objections to the insurance provider, or the specific coverage offered.
5. They may be planning to leave the company soon and want to avoid committing to a long-term insurance package.
Employers must respect an employee’s decision if they decline the insurance offer. However, employers should also ensure that employees fully understand the implications of their decision and provide them with any necessary information or resources to make an informed choice.
Since Obamacare, or the Affordable Care Act (ACA), was enacted, you are entitled to essential health benefits in your group health insurance plans. The Affordable Care Act covers most basic medical necessities. However, it’s crucial to understand what services you need your insurance policy to cover in English.
The benefits that the Affordable Care Act provides include:
Being outside of the network can drastically increase insurance costs for employees. The individuals who rely on your collective health insurance might face unexpected, out-of-pocket expenses. This can immensely add to the financial burden, sometimes costing your employees tens of thousands of dollars.
Taylor Benefits Insurance offers centralized access to all of the most significant insurance networks, giving your employees the power to access affordable care in various locations on the large group market.
Your group health plan members can’t always control where or when an injury occurs. The right to essential medical care during an emergency is vital. But sometimes that means your employees get treated out of your network.
We assure that your employees are covered by a large group coverage no matter where they happen to be.
Need assistance finding the perfect group insurance plan?
Different insurers specialize in various types of collective health packages. It’s essential to understand how these various plans could better serve your employees’ rights to quality, affordable healthcare. Some companies may offer excellent dental insurance, while others specialize in handling major employee life events, including the provision of coverage for children. Determining which large group company is the right fit for you and your employees can often feel like navigating a bustling marketplace such as healthcare.gov.
The answer to this question depends on what you need in a group health plan. Most insurers are primarily interested in closing a deal, so you might not be able to rely on their benefits and premiums information. You want a person-focused approach that understands your needs. That’s why it’s best to have an insurance broker like us choose your health insurance company for you, ensuring you get the right amount of coverage.
Taylor Benefits Insurance connects you with several of the large group medical coverage providers in the country. Whether you are an individual person or a company owner, you can always rely on us to negotiate you a favorable deal on your large group coverage programs.
As your insurance broker, we take care of all the details for you, leaving you with more time to focus on running your business or managing your personal needs. With our full range of insurance providers – from those catering to children to services for adults, as featured on healthcare.gov – you can be sure you’re getting the best deal on the large and small group markets.
The market for collective health insurance is a complex matter for large employers. With so many large team health providers competing for the same clientele, it can be difficult to find a large group market company that serves your own needs well enough. Moreover, the amount of coverage each company provides may vary, affecting the overall value they offer.
Here’s a breakdown of some of the most popular medical coverage providers out there, including their enrollment advantages and drawbacks.
We can help you find the right group insurance plan
Kaiser Permanente is one of the largest provider network options for large group coverage. As of 2021, Kaiser Permanente provided health insurance coverage to more than 12.5 million health plan members, including adults and children. It also has more than 724 medical facilities spread throughout the United States for managed care services, preventive care and more, making it a prominent player even on platforms like healthcare.gov.
An experienced company for large group coverage, Kaiser boasts over 12.5 million members and 724 medical facilities around the country. These facilities offer various services, with the amount of care given reflecting their dedication to providing comprehensive coverage for employees at nominal premiums.
United Healthcare provides large group health coverage to a huge number of Americans. It offers everything from basic health plans to prescription drug coverage, eHealth service, HSA (health savings account)-eligible packages and more. It has more than 49.5 million customers across the world, mostly located in the United States, and has many collective plan options available for employees.
This insurance company serves over 49.5 million clients worldwide, though most of them reside in the United States. It offers large team healthcare benefits option as well in an effort to cater to the diverse needs of each person.
Aetna is a very popular provider of business health insurance. It’s a subsidiary of CVS health, and offers a wide variety of small group health packages including medical protection for employees and family members, dental benefits, vision insurance Medicare plans and more. Its comprehensive coverage options, suitable for both adults and children, have made it a preferred choice on platforms such as Healthcare.gov.
Here’s a breakdown of some of the most popular health insurance providers out there, including their enrollment advantages and drawbacks.
Kaiser Permanente is one of the largest provider network options for large group coverage. As of 2021, Kaiser Permanente provided medical protection coverage to more than 12.5 million health plan members. It also has more than 724 medical facilities spread throughout the United States for managed care services, preventive care and more.
An experienced company for large team coverage, Kaiser boasts over 12.5 million members and 724 medical facilities around the country. They have a dedicated team in most states to offer coverage for employees at nominal premiums.
United Healthcare provides large group health coverage to a huge number of Americans. It offers everything from basic healthcare to prescription drug coverage, eHealth service, HSA (health savings account) – eligible plans and more. It has more than 49.5 million customers across the world, mostly located in the United States, and has many large team package options available for employees.
This insurance company serves over 49.5 million clients worldwide, though most of them live in the United States. It offers large group medical benefits option as well.
Aetna is a very popular provider of business medical coverage. It’s a subsidiary of CVS health, and offers a wide variety of small group health packages including health insurance for employees and family members, dental benefits, vision insurance Medicare plans and more. There are also options to compare health plans and find a plan with tax credits and subsidy benefits, thanks to health care reform.
A popular and long-standing healthcare solution for large and small group markets wanting coverage for their employees, Aetna serves as a subsidiary of CVS health.
Health Care Services Corporation is based in Illinois, but you can also get a quote in other states of the United States. It has more than 17 million members, with a wide variety of copay options and different large group health plans to fit organizations of any size, including indemnity health plans. Get a summary of benefits and a self-insured quote now to learn more.
The HCSC, operating from Illinois, provides insurance to employees all around the nation. The company gives varied health plans to both small business and large business members.
With an Anthem ID card, you can get medical care just about anywhere. Anthem is one of the largest collective health providers in the United States, and it’s part of the Blue Cross Blue Shield alliance, with more than 43 million members in the US alone. With a huge variety of team insurance options, Anthem is a good choice for small team plans and large team health plans.
Anthem is a member of the Blue Cross Blue Shield alliance, meaning that clients can receive care from many hospitals around the country including Ohio and Georgia. Small or large group, businesses of all sizes can benefit from Anthe’s health plans.
Based in Pennsylvania and Connecticut, Cigna provides medical insurance, dental, disability, life and accident insurance. It has more than 86 million customers worldwide, and more than 37,000 employees. With a wide variety of small and large team health plans available, you can easily find one that meets the needs of your organization.
The coverage Cigna provides runs in compliance with the Affordable Care Act, and the business’s offerings range from global coverage to dental packages.
With more than 3.8 million policyholders, Blue Cross Blue Shield of Massachusetts is the largest single health care provider in Massachusetts. It’s a non-profit, and the majority of its customers are subscribed through large and small group plans, though health care reform has made some self insured individual packages available.
The largest provider in its titular state, this company is a non-profit organization serving many Americans. It specializes in small and large group health plans, but some individual ones are accessible as well.
Blue Shield of California covers more than 4 million members in California, and is one of the largest insurers in the state. It works with nearly 65,000 physicians across the state, providing it with a very large and extensive network for California residents, and it works with more than 340 hospitals. It offers a wide variety of collective health solutions.
Employers use Blue Shield of California to provide collective health plans to their employees so that they get access to 65,000 physicians and 340 hospitals.
Blue Cross Blue Shield of Michigan is one of the largest state insurance companies in Michigan, and offers large and small group plans, individual employee plans, Medicare and Medicaid business plans, and more. It has more than 900,000 members and works with more than 6,000 doctors in the state of Michigan, making it a top choice for health care coverage in this state.
Blue Cross Blue Shield is the top choice for Michigan clients in the individual market group plans.
Highmark is a not-for-profit healthcare company based in Pittsburgh, and it primarily serves Western Pennsylvania, as well as some in Delaware and West Virginia, with a total of 4.5 million members. It offers individual plans as well as large group health plan options.
Highmark is a non-profit operating in Pittsburgh. It’s a relatively small company serving 4.5 million clients across Pennsylvania, West Virginia, and Delaware.
One of the largest Blue Cross and Blue Shield affiliates, Blue Cross and Blue Shield of Florida has more than 4.2 million members, providing it with a market share of nearly 30% in the state. It offers large group health plan, as well as individual, Medicare and Medicaid plans.
Florida’s division of Blue Cross Blue Shield is one of the alliance’s largest. 4.2 million clients make up 30% of the insurance market in the state.
Based in Philadelphia, PA, Independence Blue Cross serves more than 2 million members in Pennsylvania and more than 7 million people nationwide, and it works with more than 160 area hospitals and 42,000 physicians in its network. It also has a number of subsidiary insurers.
42,000 physicians and 160 hospitals make up the network of Philadelphia’s Independence Blue Cross. The company serves 9 million policyholders, a decent percentage of whom come from Pennsylvania.
Blue Cross and Blue Shield of Kansas has been operating for more than 75 years and covers more than 925,000 people in Kansas with large collective healthcare coverage, individual plans under health care reform, Medicare and Medicaid and more. It serves all of Kansas except for Johnson and Wyandotte counties.
Blue Cross Blue Shield of Kansas is a well-experienced organization in the individual market, having served for over 75 years. It currently has 925,000 users in its state.
Harvard Pilgrim Health Care is based in Massachusetts and was founded in 1994. It offers large group health plan options. Harvard Pilgrim Health Care is a not-for-profit company that serves more than 2.4 million members in New England including Maine, Connecticut, New Hampshire, Massachusetts, and Rhode Island, making it one of the largest human services insurers in the area.
Known for its large team health plan coverage, Harvard Pilgrim is another non-profit organization with 2.4 million members. It’s most active in the New England area.
Based in Missouri, Centene Corporation provides Medicaid insurance, ACA health insurance marketplace coverage, large and small group packages, Tricare and Medicare. It has more than 15 million enrolled members and is one of the largest providers of Medicare in the United States, but also offers traditional commercial insurance for companies.
From the standard commercial insurance for businesses to plans for individuals, Missouri’s Centene’s 15-million-member count makes it one of the largest Medicare providers in the nation.
Humana has over 13 million customers in the United States, making it one of the largest insurers in the country. It primarily offers large group plans and other types of employer-sponsored coverage, but also offers individual plans, Medicare, Medicaid and more. Thanks to its business size, it works with tens of thousands of doctors, healthcare facilities and hospitals across the United States.
Humana is a well-established health brand with companies and individual clients alike, bringing in 13 million customers in the United States.
This Blue Cross Blue Shield subsidiary is located in Maryland and Washington D.C. and is one of the top insurers in the area. It covers more than 3.3 million people with large group plans and individual policies and is part of the Federal Employees Health Benefits Program. It has a 75% market share in Maryland, making it the largest insurer in the state by far.
Blue Cross Blue Shield owns this division for over 3.3 million Maryland and Washington D.C. citizens, taking up the largest market share in the former.
Based in Rochester, NY, Excellus Blue Cross Blue Shield is the largest nonprofit health plan in Upstate New York. It’s been operating for more than 80 years and offers small, large group programs and other employer-sponsored packages, as well as individual coverage, with more than 1.5 million customers.
Few providers can boast the 80 years of operation that New York’s Excellus has. The company is a long-running non-profit with over 1.5 million customers.
HAP was founded in 1956 in Detroit, Michigan. It offers both small team plans and large group plans, as well as individual and family insurance. It’s available throughout the entire state of Michigan, with hundreds of thousands of customers in the area. It offers unique features like discounts for healthy lifestyles, digital ID cards and electronic benefits statements.
This Michigan-based provider specializes in business, group, and family insurance packages, having served the state for over 50 years.
The cost of offering employee health insurance varies depending on several factors, but here’s a general idea:
National Averages (2024):
As the only licensed Blue Cross Blue Shield member in the state, Horizon Blue Cross Blue Shield Of New Jersey provides individual, large and small group coverage to more than 3.3 million people in the state. With thousands of doctors and a wide range of medical facilities, it remains the top choice for health care coverage for small group market in New Jersey.
Over 3.3 million residents of New Jersey are under an insurance plan from this provider. The network in question involves thousands of doctors across multiple hospitals in the state.
Based in Iowa, Wellmark Blue Cross and Blue Shield of Iowa is the largest insurer in both Iowa and South Dakota, with more than two million members. It offers health insurance, dental insurance, life insurance and ACA insurance, and is a great option for large group health plan in Iowa and South Dakota.
2 million policyholders across Iowa and South Dakota enjoy medical coverage from Wellmark. If you are an employer looking for large group programs, Wellmark should be on your list.
One of the dominant insurers in the state, Blue Cross Blue Shield of Tennessee offers large group plans, Medicare and ACA individual & family insurance. This not-for-profit company serves more than 3.5 million covered individuals in Tennessee and is one of the best options for employer healthcare benefits in the state.
A non-profit responsible for over 3.5 million individuals, Blue Cross Blue Shield’s Tennessee division remains as one of the best providers in the state.
Priority Health is another top Michigan health insurance provider for large and small group market plans, family & individual insurance, and Medicare and Medicaid, and it currently serves the entire Lower Peninsula of Michigan. It has more than 830,000 covered individuals and employees under its various employer programs.
Priority Health primarily serves 830,000 clients in the lower section of Michigan. It’s widely regarded as an excellent option for employee health insurance in the area.
Premera Blue Cross is based in Washington, and it primarily operates in Washington, Oregon and Alaska. It serves a total of more than 2 million people with group insurance coverage, individual and family plans, and Medicare plans. In total, it has more than 38,000 partner physicians, hospitals and health care facilities in Alaska, Oregon and Washington.
This Washington-based provider serves not only the titular state but also Oregon and Alaska. Over 2 million clients enjoy the company’s many doctors and health care facilities.
Tufts Health Plan is based in Massachusetts, and is part of Tufts Associated Health Plans, Inc. It had more than 1 million members as of early 2019, with a network of 110 hospitals and 51,000+ health care providers, making it one of the largest providers in New England, along with Harvard Pilgrim Health Care.
Tufts owns a network of over 50,000 physicians and 110 hospitals, making it one of the largest New England health insurance companies.
Decide whether a large group health program is right for you and your employees.
If you have no need for extended coverage for employees, and the essential health benefits required under Obamacare are enough, you may decide to go with a smaller employers’ plan.
Are you looking for broader and more comprehensive health care coverage for your employees? Consider contacting an independent agency that specializes in this marketplace.
Let Taylor Benefits be your broker, contact us today!
We can help you find the right group insurance plan
Written by Todd Taylor
Todd Taylor oversees most of the marketing and client administration for the agency with help of an incredible team. Todd is a seasoned benefits insurance broker with over 35 years of industry experience. As the Founder and CEO of Taylor Benefits Insurance Agency, Inc., he provides strategic consultations and high-quality support to ensure his clients’ competitive position in the market.
Todd Taylor with Taylor Benefits gives our small business the kind of personal service we need. Insurance benefits are important to our employees and Todd helps us find a balance between benefits and value. Todd responds immediately to my phone calls & e-mails. He has even gotten in touch with me on a Sunday when we were in need of coverage answers immediately. We are very pleased with the hands-on service Todd and his staff provide.”
-Ken and Linda Orvick, Orvick Management Group, Inc.
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