How group plans work
What you decide as the owner, where prices come from, enrollment minimums, renewals and the rules in your state.
What you decide
- Which plan or plans to offer: one, or a few at different price points.
- How much of each employee’s premium you pay (carriers usually ask for at least half), and whether you help with spouses and children.
- Who’s eligible, such as employees working 30 or more hours a week, and how long new hires wait (no more than 90 days).
- Employees pay the rest through payroll, before tax.
Where prices come from
- Carriers file their rates with state regulators. DwellZip shows those filed rates, not guesses.
- Price depends on each person’s age (a 64-year-old costs about three times a 21-year-old) and on your business’s pricing region.
- Health history doesn’t change the price.
Enough people must enroll
- Carriers, and some states, require a minimum share of eligible employees to enroll. Employees covered elsewhere (such as a spouse’s plan) usually don’t count against you.
- Every year from November 15 to December 15, carriers must accept groups that miss the minimums.
Plans renew every year
- Prices and plans can change at renewal, usually with a notice about 60 days before.
- Renewal is a good time to compare again, or to ask agents for proposals.
The rules in your state
Each state sets its own small-group rules: who counts as a small group, enrollment minimums, coverage after leaving a job, and more.
Prices for your team, soon
DwellZip is launching soon: carriers’ filed rates for your area and your employees’ ages, then options from licensed agents. What’s coming
Next guide: Metal levels and plan types