01
The contribution split
What the company pays toward employee-only versus family cover. The single biggest lever on your total spend, and the one employees feel most directly. Carriers also set minimum contribution levels you must meet.
Coverage · 01
Group medical, marketed properly rather than renewed by default.
The largest line in your benefits budget and the one where broker effort shows up most plainly. Two groups with the same census get different quotes depending on whether anyone wrote the submission or simply forwarded the spreadsheet.
What we need to market a group
- Employee census with dates of birth and zip codes
- Current plan documents and rate sheet
- Renewal letter, if it has arrived
- Claims experience, where the carrier releases it
About ninety minutes of your time. We chase the rest from your incumbent.
The first real decision
How the plan is funded, before which plan.
Most small groups are never shown this choice, and for a healthy group it is often worth more than switching carriers.
Approach
How it prices
Who it suits
Fully insuredThe default
A fixed monthly premium. The carrier takes the claims risk entirely. In the small-group market rates are largely community-rated, so your own claims experience has limited effect.
Groups that want a predictable line in the budget, groups with known high claims, and anyone who does not want to think about this again until next year.
Level-fundedWorth quoting
A fixed monthly amount that funds expected claims plus stop-loss cover and administration. If the group runs better than expected, a share of the surplus can come back. If it runs worse, stop-loss caps your exposure.
Healthier-than-average groups, typically fifteen employees and up, with the cash-flow tolerance for variability and an appetite to see claims data. It requires medical underwriting to enter.
Self-fundedRarely at this size
You pay claims as they arrive, with stop-loss above. Real administrative burden and genuine month-to-month variability.
Generally not a fit under fifty employees. We mention it so you know it exists and know why we are not recommending it.
[ Describes funding structures generally — no rates, percentages, surplus-share terms or stop-loss attachment points stated. Small-group rating rules differ by state; verify the community-rating characterisation for WA, OR and ID before publishing. Level-funded arrangements have ERISA implications that need counsel. ]
Plan design
Six levers, and only one of them is the carrier.
When a renewal comes in high, changing carriers is the blunt instrument. These are the adjustments that usually move the number more, with less disruption to your employees.
02
Deductible and out-of-pocket
Raising the deductible lowers premium. Pairing a high deductible with an employer HSA contribution often lands better with employees than a smaller deductible with no account.
03
Network breadth
Narrow and tiered networks price below broad PPOs. Worth real money — and worth checking against where your people actually live, which in a three-state footprint is the question that sinks otherwise good plans.
04
Two plans instead of one
Offering a lower-cost base plan and a buy-up lets employees who want richer cover pay the difference. Usually improves satisfaction and reduces company spend at the same time.
05
Effective date
Moving your plan year can occasionally reach better rating. Rarely the main answer, and worth knowing it is available — particularly for a first-time plan that has not yet fixed a date.
06
The carrier
Last on the list deliberately. Changing carriers means new cards, new networks and new prior authorisations for anyone mid-treatment. Worth doing when the gap is real; disruptive when it is marginal.
Where broker effort shows
A submission is an argument, not a spreadsheet.
Underwriters price uncertainty. A census with dates of birth and zip codes tells them almost nothing about your group beyond demographics, so they price to the class average.
What moves a quote is context: that your turnover is low, that you added six people in engineering rather than in a high-claims trade, that the one large claim last year was a one-off surgery rather than an ongoing condition. None of that appears in a spreadsheet and all of it is legitimate.
We write that up. Every group goes out with a narrative alongside the data, and you see the marketing report — which carriers were approached, which quoted, which declined and the reason given.
Start a submission
Questions
Asked most about group medical.
Five of about thirty. The rest are grouped by subject.
All questionsHow much of the premium do we have to pay?
Carriers set a minimum employer contribution toward employee-only coverage as a condition of writing the group, and a minimum participation percentage among eligible employees. Both vary by carrier and by state.
Above those floors it is your decision, and it is the largest lever you control. We model several splits so you can see the effect on both the company line and the employee paycheck before you decide.
Can we offer benefits to some employees and not others?
You may define eligibility by objective class — full-time versus part-time, hours worked, waiting period — but you cannot pick individuals, and non-discrimination rules constrain how classes are drawn. Getting this wrong has tax consequences for the whole plan.
We will tell you what carriers will accept; whether a particular class definition is lawful for your circumstances is a question for your employment counsel, and we will say so rather than guess.
Our people are spread across three states. Does that work?
Yes, and it needs designing rather than assuming. Your plan is generally sited where the company is domiciled, and a narrow in-state network can leave a remote employee in Boise effectively uncovered for routine care.
Sometimes the answer is a broader national network, sometimes a second plan. Tell us where people actually live at the outset — it is the most common cause of a plan that looks fine on paper and fails in practice.
Will changing carriers disrupt someone mid-treatment?
It can. New prior authorisations, a new formulary, possibly a different network for the treating specialist. Transition-of-care provisions exist and vary by carrier.
Before we recommend a move we ask whether anyone in the group is mid-course on something significant — and if the answer is yes and the saving is marginal, we recommend staying. That is a real reason we sometimes advise against a change.
What if we cannot hit the participation requirement?
Employees with other coverage — a spouse's plan, Medicare, or in some cases a Marketplace plan — can often be counted as valid waivers rather than as non-participants, which changes the arithmetic considerably.
Collecting proper waiver forms is tedious and it is frequently the difference between a group being writable and not. We handle the forms.
Ninety days out is the right time. Sixty still works.
Send the census and current plan documents and we will tell you whether the group is worth marketing this year or whether we should plan for next.