What Do EE, ES, EC and EF Mean? Group Health Coverage Tiers Explained
Group health rate sheets and enrollment forms use short codes for who is covered. Knowing what each tier means helps you read a renewal, set employer contributions and answer employee questions. This guide covers the four common tiers and why the structure matters.
Who each code covers
The codes are shorthand, and carriers can label them slightly differently, so check the legend on your rate sheet.
EE: Employee Only
The employee covers only themselves. This is the tier used to test whether coverage is affordable under the ACA.
ES: Employee and Spouse
The employee and a spouse are covered, with no children on the plan.
EC: Employee and Child or Children
The employee and one or more children are covered, with no spouse on the plan.
EF: Employee and Family
The employee, a spouse and children are covered. Some carriers also use a separate employee plus one tier.
How carriers price the tiers
| Structure | Tiers Used | Notes |
|---|---|---|
| Two-tier | Employee only; employee plus dependents | Simple to read, less precise on cost |
| Three-tier | Employee only; employee plus one; family | Common for small groups |
| Four-tier | EE; ES; EC; EF | The most common structure on rate sheets |
Where the tier structure shows up
Reading a Renewal
Renewal increases can differ by tier, and enrollment mix changes the total even when rates hold.
Employer Contributions
Many employers pay a larger share of the employee tier than of dependent tiers. The dollars per tier decide what employees pay.
ACA Affordability
Affordability is measured on the lowest cost self-only option that meets minimum value, which is the EE tier.
Cost per Employee
Total cost depends on how many employees sit in each tier, not only on the rate.
Employee Communications
Showing employees their own tier price makes enrollment decisions easier.
Census Accuracy
A census with the wrong tier for even a few employees changes the quote.
Why the tier mix matters for cost and communication.
Tier counts are one of the plainest signals in a renewal. If more employees move from employee-only to a family tier, cost rises even if the rates are flat, and the reverse is also true. Tracking the mix from year to year helps you understand why total spending changed and what to expect next.
The tiers also shape how employees see the plan. A family can face a very different cost from a single employee, so employer contributions, communication and any tier-based decisions deserve attention. Check that every enrollee is in the right tier. An employee listed as employee-only with a spouse on the plan, or the reverse, creates billing and eligibility problems.
Questions we get
What does EE mean on a rate sheet?
EE means employee only. Only the employee is covered.
What is the difference between EC and EF?
EC covers the employee and children. EF covers the employee, a spouse and children.
Why do some carriers have an employee plus one tier?
It prices the cost of one dependent, whoever that person is, separately from a full family.
Which tier is used to test affordability?
The employee only tier, using the lowest priced option that meets minimum value.
Can an employer contribute different amounts by tier?
Yes. Many employers pay more toward the employee tier than toward dependents. Contribution rules still apply.
Can CFH explain our rate sheet?
Yes. CFH Insurance Consultants can walk through your rate sheet and tiers. Send us the renewal.
Do all carriers use the same tiers?
Most use some version of four tiers, though some use three or add extra tiers. Check your rate sheet’s legend.
How often should tier data be verified?
At least at renewal and at open enrollment, and when employees report life events. A comparison of your enrollment records to the carrier invoice is a quick check.
The law behind this page.
Public Health Service Act section 2701 (42 U.S.C. § 300gg), fair premium rating in the individual and small group markets; Internal Revenue Code section 36B(c)(2)(C), affordability of employer coverage.
Related guides.
What Does EE Mean in Health Insurance
The employee-only tier in more detail.
How to Negotiate a Group Health Renewal
What can be negotiated.
Compare Total Cost, Not Premium
Why the cheapest quote is rarely the cheapest year.
What Is Commercial Health Insurance
The basics of group coverage.
Michigan Small Group Health Insurance Guide
Rules for groups under fifty.
Fix the Census Before You Compare
Getting the data right.
Send us your renewal.
We’ll tell you whether it looks competitive, where we see opportunity, and the five questions we’d put to your carrier. No cost, and no obligation to move anything.
The renewal letter
Your current plan summary
Contribution split by tier
Enrolled counts by tier
Four documents — two more if your group is 50 or more. Nothing else; every extra one is a reason to postpone.
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