Choose the structure that fits your team and budget. Level-funded plans can reward good claims with savings, while fully insured plans keep premiums predictable. HSA/HRA-compatible designs allow deductible flexibility and tax advantages.
- Best fit by size: 2–9 (fully insured or community-rated), 10–50 (level-funded or fully insured), 50+ (broader level-funded and self-funded options).
- Decision cues: cash flow tolerance, claims stability, network preferences, and employer contribution strategy.
Encourage preventive care and wellness incentives to reduce claims volatility. Align employer contributions to steer plan choice and support affordability across pay bands.
- Wellness stipends or screenings
- Tiered employer contributions
- Spousal surcharges/waivers
Select network types that balance access and cost. Consider reference-based pricing (RBP) options for deeper savings when appropriate.
- HMO/EPO/PPO trade-offs
- Narrow networks with quality metrics
- RBP education and member advocacy
Manage Rx trend with formulary strategy and carve-outs where available. Keep plans compliant with ACA, ERISA, and state rules.
- Formulary tiers and prior auth
- Specialty Rx management
- 1095-C/5500 applicability by size
Most carriers write groups starting at 2 employees (varies by state). Participation and employer contribution minimums apply.
- Size: typically 2–50 for small group rules
- Participation: commonly 60–75% of eligible
- Employer contribution: often 50%+ of employee-only premium
Gather a simple census and entity documents to quote. We’ll guide enrollments and renewal timing.
- Needed: employee census, wage/tax docs, prior coverage
- Effective dates: 1st of the month
- Lead time: quotes in 2–5 business days
- COBRA/admin: we’ll coordinate as needed
Carrier, network, and plan availability vary by employer size, industry, and location. We’ll confirm options for your group and explain trade-offs between access and cost. Learn more about who we are on our About page.
How are level-funded rates set? Based on census, industry, and claims risk factors, then adjusted at renewal by actual experience.
Can we get money back? Many level-funded plans return surplus after claims and fees—varies by program.
What are minimum group sizes? Typically 2 employees (some carriers require 5+ for level-funded). We’ll confirm for your SIC and state.
Do pre-existing conditions affect eligibility? ACA rules apply to small group; underwriting may apply for some level-funded programs.
How long does enrollment take? Quotes in 2–5 business days; implementation usually 2–3 weeks from decision.
What about COBRA? We coordinate COBRA administration when applicable.
Can we cover out-of-state employees? Yes, with national networks or state-specific plans as needed.
What if we’re mid-year? We can evaluate off-cycle changes or set effective dates for your next renewal.
We’ll compare carriers, networks, and funding arrangements to find the right fit for your business.
- Email: info@coastalbig.com
- Phone: (856) 238-5001
- Helpful link: Contact & Quote
