Understanding Small Group versus Large Group Health Insurance



Many companies are getting notices now.


Scary notices about their company health insurance.


We've warned all our clients in advance but some companies are finding out from the carriers.

A few months before the change.

Due to the ACA law, many companies that had large group plans, rules, and rates are now being forced to move to Small Group.

It's a whole different world.


And this world can be expensive!


If you go blindly.

Let's look at who is affected and what's the best action to reduce costs.

ACA affect on Large group companies


Basically, the definition of "Small Group" is changing.


Companies that had 50-99 employees before now were considered Large Group.


There are certain rules that differ between large group and small group health plans.

Rules that have a big impact on companies options and costs.


We've seen migration rates increase 20-40% when companies move from large to small group and do nothing.


It's a big deal.


We can help you avoid this big hit with our 20+ years experience in the small group California market.

Why the big changes?


1. Composite rating


Large group is simplified in that rates are per person, regardless of age.


Whether an employee is 25 or 55, the rate is the same.


Also, each dependent child isn't individually rated.


These two rating attributes change for Small Group.


With Small Group, each person's rate is based on his/her age. This is even true for dependent spouses and children.


Also, each child is rated (based on age).

The net effect?

The 20-40% difference in costs on average!

If a company has older employees on average with larger families, they may find rates increase significantly under Small Group Rating.

We'll give you our secret on how to navigate this change with the best result in terms of costs below.

Feel free to request your group health quote or call us at 866-486-6551.  For companies with 20+ employees, request online census link.


2. Plan Benefits


There are big differences between large and small group benefits as well.

Small Group benefits must conform to the new ACA list of Essential Health Benefits.

It's the Bronze, Silver, Gold, and Platinum levels of benefits.


Large group has a great deal more flexibility in terms of how benefits are structured.


The California carriers could (and would) create benefits based on the employer's needs and budget.


That's no longer the case.


Here's the general breakdown for the new benefit levels:


  1. Bronze: Avg $5K deductible, limited copays, and approx $6K max out of pocket
  2. Silver: Avg $2K deductible, copays for office and rx; and approx $5-6K max out of pocket
  3. Gold: Avg $500 deductible, richer copays for office and RX, approx $5K max
  4. Platinum: low to no deductible, richest copays, Approx $4K max


The carriers have some leeway on how they reach level (higher deductible but richer copays, etc) but above are general expected benchmarks.

The problem is that many large groups would combine higher deductibles with richer copays.

That's harder in the new scheme of things (somewhere between a Bronze and Silver; but not exactly either of them).

We're happy to walk through the new Small Group benefits or request your full proposal here:


So what can we do?

Strategies to offset move from Large Group to Small Group health plans



If you're getting the notice of the new plans and freaking out.

Take comfort...there are options.


Here's your battle plan.


1. Quote Small Group Carriers


Here's the big secret that your agent should have told you and your carrier would never tell you.

The California carriers that are strong for Large Group (due to pricing) are generally NOT the best priced on Small Group.


This happens to be the case for the biggest Large Group carriers like United and Aetna.

United and Aetna are major players in the large group market.


For good reason.


They were priced really competitively for 50+ employees.


They are quite a bit more expensive comparatively on the Small Group market.


If you have United or Aetna for large group, we need to run a quote right away!


They're not the only large group carriers with this situation but the net net is this...


There's never been a more crucial time to re-quote your company across all Small Group carriers.


That's the first thing we'll do for you.


Nice thing is....


Since the plans are standardized (bronze, silver, gold, and platinum above), we can quickly quote all the plans and see who is priced best for a given benchmark plan.


We'll first run this "Summary" report across all the carriers based on your company census and send to you within 24 hours for most cases.


There's no cost for our services as licensed California group health agents for the following carriers:

  1. Kaiser
  2. Anthem Blue Cross
  3. Blue Shield of California
  4. Aetna
  5. Health Net
  6. United Health
  7. Humana
  8. CalChoice
  9. Covered California
  10. VSP
  11. Delta


and more!

Request a secured email to send your census to here: help@california-group-health-insurance.com 

Options once best Carrier Value is Established

Once we find the best value on the Small Group market, we still have some magic to work


Defined Contribution


We can establish a fixed contribution (either a % of a given plan or a fixed dollar amount) that the employer pays for each employee.


This allows an employer to protect their employee benefit budget.


Here's the better part...


We'll generate a worksheet for each employee (can include medical, dental, vision, and life if employee wants)


The worksheet will show all the plans available (can be HMO, PPO, HSA, etc) with their out of pocket based on the company contribution.


It's the best approach:

Employer can establish monthly budget
Employees can pick/choose according to health care needs, doctors, and budget

We can even use a Private Exchange to combine different carriers (think Kaiser with Health Net PPO, etc)


That's our second benefit we'll provide to all companies at no cost! Our services are free.


Request your Small Group quote or call 866-486-6551.

New Ways to Save on Small Group Dental


Finally, we'll fully quote and vet the other benefit options.


Dental comes to mind!


Here's the deal...


For companies with 10+ employees, there are new options available where carriers are very aggressive on pricing for Richer benefits and networks

We're seeing savings of $10-14/employee/month and up to $30/month for families.

For a company with 20 employees, that can quickly be $4-5K/year.


And we'll get richer benefits and networks in most cases.


For this reason, we'll fully quote the new options for your company to make sure you have the best rates for Small Group dental.

Quick Summary of Large Group to Small Group Renewal


Hopefully, we've added a ray of hope to what was an increasingly dire outlook.


You should already have a full market comparison with all carriers included and the new dental options plus new Private Exchange proposals.


If not, you're being well served.


The carriers definitely won't do this for you. They have no incentive to showing you that other carriers are much competitive in the Small Group market.


We do. There's no cost for our services but we want to earn your business as licensed California Small Group agents.


Call us 866-486-6551 or request your Small Group health quote.

For companies with over 20+ employees, just email help@california-group-health-insurance.com  and we'll email the online census link.

Call us at 866-486-6551 or request your Company Health Quote.

Anthem group health quote
Blue Shield of California group health quote
Kaiser business health quote
Health net California business health quote
Aetna group health quote
and more

Thousands of Californians
Hundreds of California Companies


Thousands of Californians
Hundreds of California Companies

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About CaliforniaGroupHealth


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