August 6, 2025
Curious about setting up the best health insurance plan for your business?
Welcome to the world of large group health insurance.
If you're a company with 50 or more employees, you know the struggle is real when it comes to finding and administering affordable and comprehensive coverage. It's easy to get overwhelmed by the myriad choices, rules, and best practices involved. You want to make smart choices that meet your employees' needs and make financial sense for your business, but where do you start?
In this article, we'll unpack the essentials and help you set yourself up for success.
Large group health insurance is a type of insurance policy that's designed for businesses with a substantial number of employees. But before you get ahead of yourself by choosing a package that may or may not suit your employees, here are some important things to note.
Large group health insurance is typically available to companies with 51 or more employees in most states.
You might also hear this called "employer-sponsored insurance" or "group health insurance." However you refer to it, the most significant distinction between large and small group coverage is the vastly different rulesets.
As reported by Forbes, the US group health insurance market reached a valuation of $1.41 trillion in 2024, offering coverage to over 40 million individuals and is set to grow steadily by 7.3% CAGR from 2024 to 2030.
The providers are different, plan designs vary, and the carriers have more power to negotiate rates.
Understanding these basic differences is critical before you shop for insurance plans.
Why is this important?
A substantial number of Americans (48.5%) obtain their health insurance through employer-sponsored group health plans. These can include HMO, PPO, POS, HDHP, or SO plans. That's over two out of every five people in the country who rely on their employer to get health coverage. Your employees expect you to provide this benefit, and they'll hold you to it.
Managing costs without sacrificing coverage is the most significant challenge for most employers.
Here are some quick stats to show you just how quickly costs have skyrocketed in recent years.
These are trends, not going to change anytime soon.
But there are several things you can do to keep costs under control, including:
The key is striking the right balance between affordability for your employees and comprehensive coverage that provides real value.
Employees need to feel secure, but your business needs to remain profitable.
If you're a business with 50+ full-time employees, you have a responsibility to comply with the ACA's employer mandate.
Here's what that means:
Bonus tip: Some employers think they can get around these requirements by hiring part-time workers instead of full-time. This won't work.
The IRS is onto these tactics and will count part-time employees as "full-time equivalents" to determine if you meet the mandate. So, if your part-time employees collectively add up to 50 full-time equivalents, you're still required to offer coverage.
Did you know that employee satisfaction with healthcare benefits is a top priority for most businesses?
As per data from UHC Small Business Benefits survey, employers rank healthcare benefits extremely important, with 88% giving it the highest importance.
Offering coverage alone isn't enough anymore. In fact, here are the things that employees say they value the most when it comes to health insurance:
The companies that excel at employee satisfaction with benefits tend to focus heavily on communication and education. They don't just mail benefits packets and enroll their staff and call it a day.
If you haven't noticed already, you have more power to negotiate as a large group plan administrator.
Carriers are eager for your business, and the size of your workforce gives you leverage. You can often secure better rates and more tailored network designs that suit your employee demographics.
Your options when it comes to provider networks include:
A younger workforce might prioritise lower premiums over expansive provider lists. Older employees will often demand broader networks and more robust coverage.
Companies that are ahead of the curve are integrating tech to improve their health insurance programs.
Some of the most popular tech integrations these days are:
These aren't just bells and whistles that make employees' lives more convenient. These solutions can help you reduce your total healthcare costs by encouraging preventive care and appropriate utilisation.
The healthcare landscape is not static. It changes rapidly as regulations, costs, and expectations evolve.
If you're only planning for the here and now, you're likely to encounter problems in three years when those plans need renewing.
Smart business owners build flexibility into their strategy to account for:
The best course of action is to choose carriers and benefit administrators that will adapt with you and your company as your needs change.
Ready to get started on choosing the right large group health insurance plan for your business?
Excellent. Now that you have a basic framework, here are the next steps.
Don't try to tackle all this alone. The stakes are high, and the available options are complex. Seek help.
Setting up the right health insurance plan for your business is not just a compliance checkbox to get you off the hook legally. It's a strategic decision that will attract talent, retain employees, and support your company's long-term success.
The organisations that do it best focus on three core principles: smart cost management, solid compliance, and real employee satisfaction. Good insurance is an investment in your workforce, not just a line item on the expense report.
Remember: The US group health insurance market is growing at 7.3% CAGR from 2024 to 2030 and will reach a market valuation of $1.61 trillion by 2030, that you're operating in a rapidly changing business environment. The choices you make today will have a lasting impact on your company for years to come.
Take the time to get it right. Your employees (and your bottom line) will thank you for it.
In most states, a business is classified as a large group for health insurance if it has 51 or more full-time equivalent employees. This distinction is important because the rules and plan options differ significantly from those for small groups.
Companies can manage costs by offering high-deductible health plans (HDHPs) paired with Health Savings Accounts (HSAs), using tiered provider networks to encourage cost-effective care, implementing employee wellness programmes, or even considering self-funding a portion of the plan.
The Affordable Care Act (ACA) requires businesses with 50 or more full-time employees to offer affordable, minimum-value health coverage to at least 95% of their full-time staff and their children. Failing to do so can result in substantial financial penalties.
Network design directly impacts both cost and employee satisfaction. Large employers have the leverage to negotiate different types of networks, such as broad, narrow, or tiered, to strike a balance between providing ample provider choice and keeping premium costs manageable.
Integrating technology like telemedicine platforms, wellness apps, and AI-driven benefits tools can make healthcare more accessible and convenient for employees. These tools can also help lower overall costs by encouraging preventive care and helping staff make more informed decisions about their health.
