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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.
Here's how a business might qualify for large group coverage:
Remember, the distinction between small and large group 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-group health plans, but they offer more flexibility and customization options. Small-group plans can be tailored to the specific needs of the business and its employees. They may also 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 plans, but they offer less flexibility and customization options. Large-group plans are standardized and must meet certain requirements set by the government. They may not offer the same level of additional benefits as small-group plans.
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 depend on a number of factors, including the number of employees you have, your budget, and the specific needs of your employees. If you have a small business with a tight budget, a small-group health plan may be a good option. If you have a larger business with more employees, a large-group health plan may be a better option.
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. You can also get help from a health insurance broker or agent.
Today’s insurance market consists of many companies competing for a fixed number of customers.
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.
The demand for excellent health insurance is rising for many reasons, including these:
But individual insurance coverage are often not affordable with high premiums.
Some insurance providers started offering cheap coverage through the state and federal exchanges as required by the ACA. Later, it became clear that this coverage was not sustainable at competitive rates, so 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 health insurance plan that your employees can rely on.
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:
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. That’s why we take the time to get it right for small group market and group market.
A health insurance plan is an insurance plan that covers a group of over 50 employees.
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 health insurance that will meet your employees' needs.
This coverage tend to be comprehensive and flexible enough to accommodate the needs of subscribers with divergent requirements. Often, a group plan offers people with special health needs complete confidence in their coverage.
Coverage can be flexible and comprehensive.
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.
This health plan is often the best option if you are running a business with at least 50 employees. A group coverage plan 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.
This may also be ideal for student health insurance. The group health plan is well-suited to groups of individuals that can’t afford comprehensive individual health insurance.
Do you have questions about what Taylor Benefits Insurance can do for you?
We can help you find the right group insurance plan
There are several types of coverage that you can choose from. Each of them have unique pros and cons based on the coverage and resources you require for you and your employees.
Group health plan 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 modern market keeps insurance companies always on the lookout for new customers and their family members to offer health plans. Insurance providers are happy to give generous discounts off their standard rates for these health plans since they are getting a lot of guaranteed business over the terms of a contract.
Group health insurance is a good deal for employees, but how much does it cost employers and small employers? Most states mandate group health plan for employees, so taking care of your employees is in your interest.
The average group 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.
Costs are split for your employees’ insured group health insurance premiums between you and each employee. Both you and your employee will save money when you implement a group health plan.
Employers will pay between 70 and 90 percent of the group health insurance premium for the insured large group coverage, depending on what the employee can afford. Subsidized coverage is also available for employees who can’t pay for their healthcare by themselves.
Employees that want to opt into your group health insurance plan but can’t afford it themselves can still apply for enrollment with the largest companies such as Anthem. The government provides subsidies and financial assistance to individuals who are below a certain level of poverty.
These subsidies apply to large group plans just as much as to an individual market plan. The ACA requires that everyone have some level of health insurance. Government grants have been put into place precisely for this exact reason.
If you have a big group, the health plan will provide complete 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 when it comes to large group health insurance and small group health plans. Most group health plans will cover the basics, like life insurance and disability coverage, and may provide various coverage options based on your group’s specific needs. It can be family coverage with open enrollment from an employee at nominal premiums.
It isn’t easy to find affordable group health insurance plans that also cover all the health benefits and coverage that your employees need. Independent insurance agencies are most capable of providing you with the employee insurance policy you need. They can offer you large group health plans you will not find anywhere else.
Since the passage of Obamacare, or the Affordable Care Act (ACA), you are entitled to essential health benefits in your group health insurance plans. The Affordable Care Act covers most basic medical necessities, but not all in contrast. It’s essential to be informed about what services you need your insurance policy to cover.
The benefits that the Affordable Care Act provides include:
Getting caught out of network can drastically increase insurance costs for employees. The people relying on your group health insurance might end up having to pay out of pocket costs. Uninsured service can cost your employees tens of thousands of dollars.
Taylor Benefits Insurance offers centralized access to all of the most significant insurance networks on the large group market.
Your group health plan members can’t always control where or when an injury occurs. The most important thing is that your employee receives essential medical care during an emergency. But sometimes that means you get treated out of your network.
We make sure that your employees are covered by a large group coverage no matter where they happen to be.
We can help you find the right group insurance plan
Different insurers specialize in various types of group health plans. Some companies may offer excellent dental insurance, while others specialize in handling major employee life events. Which is the right large group company for you and your employees?
The answer to this question depends on what you need in the 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. That’s why it’s best to have an insurance broker choose your health insurance company for you.
Taylor Benefits Insurance connects you with several of the large group health insurance providers in the country. No matter what happens, you can always rely on us to negotiate you a favorable deal on your large group coverage plans.
As your insurance broker, we take care of all the details for you, leaving you with more time to focus on running your business. With our full range of insurance providers, you can be sure you’re getting the best deal on the large group and small group markets.
The market for group health insurance is a complex matter for large employers. With so many large group health providers competing for the same clientele, it can be challenging to find a large group market company that serves your own needs well enough.
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 health insurance 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 group 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 health plans 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 group plan 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 health plan benefits option as well.
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 plans 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 group 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 group 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 group insurance options, Anthem is a good choice for small group plans and large group 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 group 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 group and large group 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 plans.
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 group and small group plans, though health care reform has made some self insured individual plans available.
The largest provider in its titular state, this company is a non-profit organization serving many Americans. It specializes in small group 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 group health plans.
Employers use Blue Shield of California to provide large group 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 group plans, 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 group health plan 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 insurer in the area.
Known for its large group 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 group health plans, small group plans, 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 group and large group plans and other employer-sponsored plans, 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 group 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 plans, having served the state for over 50 years.
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 health insurance from Wellmark. If you are an employer looking for large group plans, 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 health insurance 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 group plans, 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 plans.
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 plan 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
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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