Small group health insurance
Small group health insurance is the traditional way to cover a team of 1 to 50: one carrier, a fixed monthly premium and ACA protections that keep health history out of your price.
Best fit: Most teams of 1 to 50 that want a traditional plan
How small group health insurance works
You pick a plan, or a few plans, from a carrier that sells in your area. The carrier quotes a monthly premium for each employee based on the rules below. You pay part of that premium, employees pay the rest through payroll, and the carrier pays claims.
Your cost is set for 12 months. A rough claims year does not change your bill until renewal, and even then the carrier must price your group with ACA small group rules.
What ACA rules guarantee
- Guaranteed issue. Carriers must accept any small employer that meets their participation and contribution rules.
- No health questions. Prices can vary only by age, location, tobacco use and family size.
- Full benefits. Every plan covers the ten benefit categories the ACA requires, including hospital care, prescriptions, maternity and mental health care.
- A cap on waiting periods. New hires cannot wait more than 90 days for coverage to start.
The small group market covers employers with 1 to 50 employees in most of the country. Four states, California, Colorado, New York and Vermont, extend it to 100.
Choosing a plan design
Plans differ in two ways: how costs split between the plan and the employee, and which doctors are in network.
- Metal tier. Bronze plans have the lowest premiums and the highest deductibles. Gold and platinum plans cost more each month and less at the doctor. Silver sits in the middle.
- Network type. HMO and EPO plans limit care to a set network and usually cost less. PPO plans add out-of-network coverage at a higher premium.
- HSA-qualified plans. A high deductible plan paired with a health savings account lets employees set aside pretax money for care. You can add employer HSA deposits too.
Many employers offer two plans: a lower premium option and a richer one. Employees pick, and your contribution stays predictable.
What it costs
KFF's 2025 Employer Health Benefits Survey puts the average yearly premium at $9,325 for single coverage and $26,993 for family coverage. Your numbers depend on your team's ages, your location and the plan you choose.
Most carriers ask you to pay at least half of each employee's own premium. Covering dependents is your call. Read how participation and contribution rules work.
Source: KFF, 2025 Employer Health Benefits Survey.
When another option fits better
A fully insured plan is the safe default. It is not always the cheapest.
- A young, healthy team may pay less with a level-funded plan.
- A team spread across states, or an owner who wants a fixed budget, may do better with an ICHRA.
- A team of a few people with no group plan today might start with a QSEHRA.
We price these side by side so you can see the trade-offs in dollars, not sales language.
Small group health insurance by state
Carriers, networks and prices change at every state line, and sometimes at county lines. Kansas splits its Blue plans by county, and Missouri has four carriers competing for small groups. Read the Kansas small group market guide or the Missouri small group market guide, or find your state on the states page.
How we quote it
Send us your ZIP code, team size and current plan if you have one. We pull plans from the carriers selling in your area, line them up by premium, deductible and network, and walk you through the differences. When you pick one, we handle the application and employee enrollment, then recheck the market before each renewal.
Compare your options
Tell us about your group. A licensed agent compares the carriers in your area and follows up with options.
Common questions
Something else? Ask a licensed agent.
What is a fully insured small group plan?
It is a health plan you buy from an insurance carrier for your employees. You pay a fixed monthly premium, and the carrier pays the claims. If claims run high, the carrier takes that risk, not you.
Can I offer my employees more than one plan?
Often, yes. Many carriers let small employers offer two or more plans side by side, such as a lower premium plan and a richer one. Your contribution can be set off one plan, and employees pay the difference for the other.
Can a carrier turn my business down because someone is sick?
No. ACA small group plans are guaranteed issue. A carrier cannot refuse your business or charge more based on anyone's health, as long as you meet its participation and contribution rules or enroll during the November 15 to December 15 window.
Can owners and family members join the plan?
Owners can usually join as long as the plan also covers at least one employee who is not an owner or an owner's spouse. Spouses and children join as dependents of an enrolled employee.
How fast can a new plan start?
Most small group plans start on the first of a month. Carriers usually need the signed application and employee enrollments a few weeks before the start date, so plan on 30 days or more.
Other ways to cover your team
Compare all plan types- Level-funded health plans Best fit: Healthier teams open to a short health questionnaire A steady monthly cost that covers claims, admin and stop-loss protection. Low claims can mean a lower rate, and some plans refund part of the surplus.
- ICHRA Best fit: Teams spread across states, or owners who want a set budget You set a monthly allowance. Employees pick their own individual plans, and you reimburse them tax free. Works for any company size.
- QSEHRA Best fit: Businesses under 50 employees with no group plan A simple reimbursement plan with yearly limits set by the IRS. A low-cost first step for very small teams.
- Group dental and vision Best fit: Any employer adding benefits beside a health plan Low-cost add-ons employees use every year. Offer them with your health plan or on their own, paid by you, your team or both.
- Group life and disability Best fit: Employers rounding out a benefits package Employer-paid life insurance plus short-term and long-term disability coverage that protects your team's income. Group rates often beat individual policies.
Get your quote before renewal
Tell us about your team. A licensed agent compares plans from the carriers in your area and sends you options.
- Free, with no obligation to buy
- Small group, level-funded and ICHRA compared
- A licensed agent handles your request