The questions employers ask us most, answered in full.
Not thought leadership. The actual questions that come up in a renewal meeting, written out properly so you can read the answer before you need it. For the year-round side of cost, see our health and cost strategy. Choosing a broker? Read our 100-employee guide, or see what the 2027 rate approvals mean for a renewal.
Four things you can use today.
Two of these are deadlines you already own. One is how we run an account. One is what this year’s renewals actually look like.
The Compliance Calendar
Every federal deadline that attaches to a health plan, with the rule stated first and the date beside it, Form 5500 and the summary annual report, 1095-C furnishing and filing, Part D creditable coverage, PCORI, and the COBRA clocks.
Everything You Owe Employees
Which notices can ride along in the annual enrollment guide, and which are event-triggered and start a clock the day the event happens. The second kind is where employers get caught.
Datum
How an account is run here: the same five stages every year, from setting the datum through to carrying the year. It starts from the position that total premium is the wrong number.
This Year’s Trend Baseline
Three lines instead of one, the national trend, what was actually filed in the market, and your own renewal history. A single benchmark number tells you very little about your own plan.
The Paperwork, Without the Meeting
The four documents to gather before a renewal review, a model authorization letter you can adapt, and the plan-year compliance checklist. No form, nothing to download.
The Glossary
Thirty-six terms that decide what you actually pay, each with what it does to your number, searchable, and written the way we would explain them across a table.
Run your own numbers.
Thirteen free calculators for the questions HR and finance teams ask most: what a renewal should look like, what a contribution costs, and what the compliance rules actually require.
Renewal Increase Checker
Enter what you pay today and what the carrier is asking. See the increase per enrolled employee, how it compares with a market yardstick, and the questions to put to your carrier. Looking for something to run the numbers on? See all of our free benefits calculators and tools.
Employee Benefits Cost Calculator
A benchmark for what a benefits package actually costs, so you are not finding out one renewal at a time.
Employer Contribution Calculator
Test three ways to split the premium between company and employees. See what each costs you a year and what it leaves for an employee-only plan.
ICHRA vs. Group Plan Calculator
Put your group premium next to a monthly ICHRA allowance. Compare the annual cost of each and see whether the allowance clears the ACA affordability line.
Group Health Participation Checker
Carriers accept, and in larger groups price, a plan on how many eligible employees enroll. See whether your group clears the minimum.
Michigan PA 152 Calculator
Enter your enrollment and total plan cost. See the most a Michigan public employer can pay toward medical coverage under Public Act 152.
ACA Affordability Calculator
Test whether your lowest-cost plan clears the affordability percentage for 2026 and 2027, using the safe harbor that fits your workforce.
Large Employer FTE Calculator
Fifty is not a headcount. Count full-time equivalents the way the employer mandate does.
ACA Employer Mandate Penalty Calculator
Two penalties apply to large employers and only one is catastrophic. Estimate both in dollars.
ACA Measurement Period Calculator
For employers with variable-hour staff, such as restaurants, hotels and seasonal resorts. Work out your look-back measurement dates.
Compliance Deadline Checker
Half the compliance calendar does not apply to you. Find out which half does.
COBRA Cost Calculator
See what continuation coverage costs, at up to 102 percent of the full premium, before the notice goes out.
HSA & FSA Contribution Calculator
See how much 2026 room is left in a health savings account or healthcare flexible spending account.
Total premium is the wrong number.
One employer, one renewal year, three true descriptions of the same increase. Which one you are shown decides what you think happened.
Total Premium
What the renewal letter said. It moves with enrollment, so it answers a question nobody asked.
Blended PEPM
Per employee per month, blended across tiers. Closer, but tier mix still moves it.
On a Held Census
The same people, priced twice. This is the only one of the three that is a rate change.
Published without the employer named. The gap between the first number and the third is not a rounding difference — it is the difference between a renewal you can argue with and one you cannot.
Some of this, we tell clients before they ask.
Eighteen short positions on questions that come up in nearly every renewal conversation — the analysis itself, not just a link to where to read more, grouped by the same five areas as the rest of the site.
Jump to a topic.
Self-funding · Reference-based pricing · Renewal
Compliance · COBRA · ICHRA · Multi-state · Fiduciary duty
Technology · Health data platforms · Payroll integration · Termination data · HSA & FSA · Claims advocacy
Self-funded is not one thing, and the paperwork proves it.
Everyday language treats fully insured, level-funded, and self-funded as points on a single spectrum of risk. ERISA uses the word "funded" more narrowly, to mean whether plan assets sit in a trust. By that definition, a fully insured plan and a self-funded plan paid from general assets are both unfunded, which is why either one can qualify for the Form 5500 small-plan exemption while a trust-funded plan cannot.
Level funding sits in the middle and gets misclassified the most often. It is self-funded up to the attachment point, so PCORI fees are still owed by the employer and Section 105(h) nondiscrimination testing still applies, even though the monthly bill looks and feels like a premium. Employers who compare funding options purely on projected savings tend to discover the second set of obligations only when a testing failure or a fee notice arrives.
Reference-based pricing is a different negotiation, not a discount.
Private health plans paid hospitals an average of 254% of Medicare rates, per RAND's most recent Hospital Price Transparency study (Round 5.1, December 2024, using 2022 data). A separate look at one national reference-based pricing program, covering roughly 300,000 lives (Health Affairs Scholar, July 2026), found inpatient claims priced at 122% of Medicare versus 240% for commercially priced claims in the same data, a real gap, though the authors are careful to call it descriptive of one program in one year, not causal proof for every employer.
That gap explains the appeal, but reference-based pricing changes who negotiates and when, moving cost containment from a rate an insurer set in advance to a per-claim conversation the member can be pulled into. We advise on reference-based pricing case by case, modeled against a client's own claims, rather than placing or administering a program ourselves. Whether it fits depends on a group's tolerance for that conversation, not just the size of the number in the analysis.
A renewal runs on two clocks, and only one of them is ours to control.
The carrier's clock starts when a complete, accurate request goes in and ends whenever underwriting finishes; how long that takes depends on the carrier and the completeness of the data, not on anything a broker can speed up by asking twice. The second clock is ours: once proposals land, turnaround is next-day, not queued behind other work. Groups often blame the wrong clock for a renewal that felt slow.
An annual notice cannot satisfy an obligation that a hire date or a plan change already triggered.
Required employee notices split two ways: what can ride inside an annual enrollment guide, and what cannot because it is tied to an event or a fixed date instead of an enrollment window. The Marketplace notice is due within 14 days of a hire date. A Summary of Material Modifications for a benefit reduction is due within 60 days of the change, not at renewal. COBRA's election notice runs on its own clock the moment a qualifying event occurs. None of the three waits for open enrollment.
We check every compliance date against the agency that owns it (the Department of Labor for ERISA disclosures, the IRS for tax-code items like Form 5500 timing, PCORI, and Section 125 testing, and CMS for Medicare Part D) rather than a broker blog or a vendor's summary page. The obligations that catch employers are rarely the well-known ones; they are the ones that do not announce themselves on a calendar built around the renewal date.
See which notices are tied to enrollment, and which are not →
Continuation coverage is not the same guarantee in every state.
Federal COBRA applies to employers with 20 or more employees and gives departing employees the right to continue group coverage, at their own cost, for a defined period. Many employers assume a state-level backstop covers everyone else. Michigan does not have one: an employer under 20 employees here has zero continuation obligation, federal or state. The size of the employer, not the reason someone left, is what decides whether continuation coverage exists at all.
Coordinating an administrator, tracking the 60-day election window and the 45-day first-premium deadline, and knowing which of those actually apply in a given state is what continuation administration is, separate from just having a policy that allows for it.
An ICHRA moves the decision. It does not remove it.
A traditional group plan puts the employer in the position of choosing the network, the plan design, and the carrier on employees' behalf. An ICHRA replaces that with a defined contribution the employee spends on an individual-market plan of their own choosing. The employer's job does not go away; it changes, from selecting one plan for everyone to setting a contribution structure, communicating how individual-market shopping works, and meeting the ICHRA's own notice requirement, due 90 days before the plan year starts.
Compliance does not average across states. It applies state by state, to wherever the employees are.
A benefits program headquartered in one state is not graded on that state's rules for employees working somewhere else. Leave law, continuation requirements, and paid-sick-time mandates attach to the employee's work location, so a multi-state employer is not running one compliance program with exceptions. It is running as many overlapping programs as it has states, each with its own accrual, notice, and eligibility rules that do not defer to each other.
Fiduciary duty follows the decision, not the title.
ERISA fiduciary status attaches to whoever exercises discretion over the plan or its assets (selecting a carrier, choosing a TPA, approving a plan design change) whether or not "fiduciary" appears anywhere in that person's job description. An HR director who signs off on a renewal without documenting how the decision was reached has taken on fiduciary risk without necessarily knowing it. Governance is what turns that exposure into a defensible, documented process instead of an assumption.
Choosing a benefits platform usually makes a bigger decision by accident.
Benefits enrollment, HR information systems, and payroll increasingly ship as one bundled contract, so selecting an enrollment platform can quietly decide who holds employee records and runs payroll too. That is a larger decision than the one most employers think they are making, and it deserves its own evaluation instead of inheriting whatever the enrollment vendor happens to include.
We advise on HR information system and payroll system selection and implementation, not only the benefits-enrollment platform, so that decision gets made deliberately before a vendor contract is signed, not discovered after.
The platforms consolidating right now are chasing scale, not your specific census.
Health intelligence platforms (the dashboards that turn claims and eligibility data into utilization trends, disease-prevalence rates, and cost drivers) are consolidating quickly, and each acquisition adds more employers and more aggregate data behind the same interface. That is real progress in how much a platform can see across the market. It says nothing about how well it explains what is happening inside one specific group.
A benchmark built on millions of lives is useful for context, not for a decision. The question an employer actually needs answered is narrower: why did our claims move the way they did this year, and what should we do about it before the next renewal. That answer comes from someone who has looked at the census behind the dashboard, not from an aggregate view of employers who look nothing like this one.
A payroll integration connects the systems. It does not connect everything in them.
The benefits platform connects directly to a range of payroll and HR systems. Once that connection is set up, demographic changes sync between the two systems within about a minute, and new hires and terminations flow from payroll into the benefits platform automatically instead of being re-keyed by hand.
What does not sync is the part worth knowing before relying on it. Deduction amounts move from the benefits platform to payroll only at enrollment or when a cost actually changes; base compensation flows the other way and is not something the benefits platform can edit; and several deduction types (401(k), commuter benefits, and domestic partner deductions among them) do not cross the integration at all, because most platforms cannot split a single deduction into a pre-tax portion and a post-tax portion. Those still have to be managed by hand. An integration that is technically live can still leave real gaps in a payroll register if nobody is watching for them.
The integration will tell payroll someone left. It will not tell it why.
None of the payroll integrations we have reviewed pass termination reason across the wire. A termination shows up in the benefits platform as a fact, an end date, but not a reason, and most platforms default it to a voluntary separation regardless of what actually happened.
That default matters because the actual reason is often exactly what determines what happens next: COBRA continuation rights, unemployment claims, and rehire eligibility can all turn on whether someone quit, was let go, or was laid off. Trusting the integration to carry that distinction means trusting a field it was never built to carry. It still has to be entered by hand, every time, in whichever system needs it.
The wrong FSA can quietly disqualify the HSA sitting next to it.
An HSA-eligible high-deductible plan and a general-purpose health FSA cannot be paired, enrolling in both makes an employee ineligible to contribute to the HSA at all, even if the FSA is barely used. Employers who add a general FSA option without checking it against an existing HSA-eligible plan can strip contribution eligibility from employees who never knew there was a conflict. A limited-purpose FSA, restricted to dental and vision, is the fix, but it has to be built that way from the start.
Processing a claim and fighting one are different jobs.
Most of what a carrier or TPA does with a claim is administration: apply the plan design, pay what is owed, move to the next one. Advocacy is what happens after that process produces the wrong answer, a denial that should not have been a denial, a bill that does not match the plan's negotiated rate, a stop-loss reimbursement that has to be requested rather than assumed. An employer needs someone assigned to the second job, not just confidence that the first one is running.
Employees compare job offers on salary because nobody hands them the other number.
A benefits package has a real dollar value (premium contributions, paid leave, disability and life coverage among them), but almost none of it appears on a pay stub or an offer letter next to the salary figure. Employees end up comparing offers on the number they can see, which undervalues employers who are actually competitive once the full package is counted. A total compensation statement puts a number next to every piece of it, once a year, so the comparison an employee is already making gets made with the right information.
A PEO changes who is responsible for the benefits plan, not just who runs payroll.
Joining a professional employer organization is usually evaluated as a payroll and HR-administration decision. It is also a benefits decision: under the co-employment structure, the PEO becomes the plan sponsor, which changes whose plan document governs, whose renewal timeline you are on, and what happens to coverage if the relationship ends. Those consequences are worth pricing in before signing, not after.
A wellness program's obligations depend on what it asks of employees, not its name.
A wellness disclosure requirement applies to health-contingent programs (the ones that reward or penalize an outcome, like a biometric target or a tobacco-free result) and does not apply to participation-only programs, where completing an activity is the entire requirement regardless of outcome. Two programs marketed the same way inside a benefits guide can sit on opposite sides of that line, and the difference decides what has to be disclosed and how.
The Part D notice has no size exemption. Every employer owes it, every year.
Most compliance obligations soften or disappear below some employee count. The Medicare Part D creditable coverage notice does not: any employer offering prescription drug coverage owes the annual notice to Medicare-eligible individuals before October 15, regardless of group size, plus a separate disclosure to CMS within 60 days of the plan year start. It is one of the few notices that catches small employers exactly as hard as large ones, which is also why it is one of the more commonly missed.
What you are actually paying for, and why it moved.
Self-Funded vs. Fully Funded Health Plans
The decision that changes everything downstream, who carries the risk, who keeps the surplus, and at what size it starts to make sense.
Employee Benefits Optimization Strategies
Where the recoverable cost usually hides, and which levers are worth pulling before you touch the plan design.
Whether your plan is competitive is a question with an answer.
Group Benefits Benchmarking: Michigan Cost Analysis
What comparable Michigan employers are paying, contributing and offering, the comparison that settles an argument in a board meeting.
Benchmarking to Attract Talent and Control Cost
Using benchmark data as a hiring argument rather than only as a cost check.
Three lines, not one — national, local, and yours
A renewal percentage on its own tells an employer nothing. It needs two reference lines above it before it can be read at all: what happened to employers nationally, and what happened in this state to this kind of plan. Only with those in place does the third line, the employer’s own number, mean anything.
Nationally, employer health costs were projected to rise nine to ten percent for 2026 before any change to plan design, and roughly six and a half to seven and a half percent after employers made those changes. The distance between those two figures is the most misquoted thing in this subject. The lower number already assumes the employer went and changed something; if nothing changes, the higher one applies.
Locally, Michigan requires fully insured small-group rates to be filed with the state, and publishes every carrier’s approved change. The statewide small-group average was approved at 11.1 percent for 2026 and is proposed at 9.6 percent for 2027. Two limits travel with those figures wherever they go: above fifty employees rates are not filed at all, and a self-funded plan has no filed rate because it is not buying one. The filed table covers fully insured groups under fifty, and even inside it, no single employer gets the published number. Michigan requires per-member rating and allows rates to vary only by area, age within a three-to-one band, and tobacco, so each group’s own renewal moves with its own census on top of the filed change. The smaller the group, the harder that average age swings on one hire or one departure.
The published statewide figure also blends two different products. Split by plan type, the 2027 filings land near eleven percent on the HMO side and near eight percent on the insurer side, against a blended headline of 9.6. Run the same split on 2026 and the gap all but disappears. So quoting the blended number at one specific employer can be close to two points wrong in either direction, and which direction it is wrong in changes from year to year.
A self-funded employer needs a different set of numbers again. Its cost is claims, administration and stop-loss, and those three move on three different clocks, stop-loss premium rose roughly fourteen to sixteen percent for 2026 depending on the deductible, because the deductible stays put while the claims sitting above it grow. An employer told the market is nine percent has been handed a figure that describes none of its three components.
One renewal cannot show a bent trend line. Establishing whether an employer’s own cost line is running below the market’s takes several consecutive renewals set against the trend for those same years. That is the analysis, and it is why the first thing we ask for is the last few renewals, not only the current one.
Bring us the last few renewals and we will draw all three lines →
What Michigan Employers Will Actually Pay in 2027
The 2027 rate filings are public. Eight carriers, a spread of 7.0 to 14.8 percent, and a statewide average that turns out to be nobody’s actual number, plus what changes the moment you pass fifty employees.
Four things that moved, and what each one does to you.
Not news. Changes with a consequence attached — written rule first, so the entry still reads correctly next year.
You No Longer Have to Mail Every 1095-C
Alongside the existing route, furnish by 31 January with an automatic 30-day extension, there is now an on-request model: post a conspicuous notice by the due date, retain the statements through 15 October, and furnish within 30 days of a request.
What it does to you. It removes a mailing, not an obligation. And several states run their own furnishing mandates that the federal relief does not override, so a multi-state workforce may not benefit at all.
The Filed Small-Group Increase Came Down
Michigan publishes every carrier’s approved change for the individual and small-group markets. Small group statewide was approved at 11.1 percent for 2026 and is proposed at 9.6 percent for 2027.
What it does to you. If you are under 50 and fully insured, that filed figure for your product type is your rate, not a benchmark. Above 50 nothing is filed at all, and the individual-market number, which is far higher, gets quoted at employers by mistake constantly.
Renewals Ran Well Ahead of Claims
Stop-loss premiums rose in the mid-teens for 2026 depending on deductible, several points faster than the year before.
What it does to you. This is leveraged trend, not a pricing decision: the deductible stays put while the claims above it grow, so ten percent on claims can produce a stop-loss renewal in the thirties with nothing unusual having happened.
More of each large claim is staying with you
Pooling attachment points moved up for 2026.
What it does to you. A higher attachment point means a claim that would once have been pooled away now sits inside your own experience. At any size, a single claimant below the point can move the number in both directions, which is also why a decrease is worth explaining rather than celebrating.
The obligations that do not announce themselves.
ERISA Compliance Checklist for Employers
Plan documents, summary plan descriptions, filings and disclosures, what is required, and what auditors actually ask for.
Employee Benefits Strategy Consulting
How a benefits program gets planned across several years instead of re-argued every fall.
Summary Plan Description vs. Benefits Guide
Why the benefits guide and the carrier certificate are both not the plan document, what an SPD has to contain, and the clock ERISA puts on furnishing it.
How the relationship actually works.
Five Questions to Ask Your Broker
What your broker should be able to answer before you sign the renewal, and what a good answer sounds like. If your broker was recently acquired, see what to check.
What is a broker of record letter?
The one-page document that moves your account, what it does, what it does not do, and what it does not cost you.
Choosing an Employee Benefits Broker
What separates a broker you hear from at renewal from one that works the account all year.
Do you need a separate life insurance broker?
Not if your benefits broker already handles it. We are licensed insurance brokers across health, dental, vision, disability, and life, a life insurance question does not have to start a new relationship with a new vendor.
Finding a health insurance broker in Michigan
Network strength varies by region, a carrier that is strong in metro Detroit can be thinner in the north or on the west side. The right broker matches the carrier to where your people actually live and work.
Michigan Employer Benefits Law, Explained
Dedicated guides to the state and federal rules Michigan employers ask about most. Each one cites the statute and tells you what to ask your carrier.
Michigan Benefits Compliance Hub
Every Michigan and federal rule that touches an employer benefits plan, in one place, with links to a dedicated guide for each. Read the guide →
COBRA Law, Notices and Timelines
Who is covered, the notices and deadlines, and what changes for employers under 20 employees. Read the guide →
Michigan Earned Sick Time Act
Accrual, caps, small-employer rules and how the law fits with your PTO policy. Read the guide →
Michigan Payment of Wages and Fringe Benefits Act
What the act says about fringe benefits, deductions and written policies. Read the guide →
Michigan Mental Health Parity Law
How Public Act 41 of 2024 applies to fully insured plans and what to ask your carrier. Read the guide →
Michigan Autism Insurance Mandate
What the statute requires of fully insured plans and where the age and cap questions stand. Read the guide →
Michigan Prior Authorization Law
Response deadlines, approval validity and what carriers must do electronically. Read the guide →
Michigan Telemedicine Coverage Law
What MCL 500.3476 requires of insurers and how cost sharing still applies. Read the guide →
Michigan Oral Chemotherapy Coverage Law
The coverage parity rule for oral anticancer medication under Public Act 170 of 2023. Read the guide →
Michigan Minimum Wage and Employee Benefits
The wage schedule through 2027 and how it touches ACA affordability and contributions. Read the guide →
Michigan Civil Rights Act and Benefits
How the Elliott-Larsen Act, including the 2024 additions, touches eligibility, contributions and plan design. Read the guide →
HSA, FSA and Section 125 Limits
The IRS limits for open enrollment, with what is final for 2027 and what is not. Read the guide →
No Surprises Act for Employer Health Plans
The federal surprise billing protections, notices and dispute process, and what is still delayed. Read the guide →
Federal Mental Health Parity
What federal parity requires and the Department of Labor enforcement bulletin of September 2026. Read the guide →
ACA Forms 1094-C and 1095-C Reporting
Who files, the deadlines, the posted notice option and the penalties. Read the guide →
Michigan Employer Benefits Law at a Glance
A printable one-page summary of the Michigan rules, with links to every guide. Read the guide →
Michigan External Review of Denied Claims
How an employee on an insured plan takes a denied claim to the state, with the deadlines. Read the guide →
Michigan Required Health Benefits for Insured Plans
The coverage the state regulator lists as required, plus the clean claims rule. Read the guide →
Michigan SSN Privacy and Data Breach Law
How Michigan law governs Social Security numbers and breach notice for benefits data. Read the guide →
Michigan Employee Right to Know Act
What counts as a personnel record, review rights and discipline record rules. Read the guide →
More Federal and Michigan Compliance Guides
Plain-language guides to rules that sit beside the main health plan requirements.
ADA and GINA Rules for Employer Wellness Programs
Why the EEOC incentive limits were vacated and what still applies. Read the guide.
Section 105(h) Nondiscrimination for Self-Insured Health Plans
The eligibility and benefits tests for self-insured plans. Read the guide.
PWFA and PUMP Act Rules for Employers
Accommodations, break time and space, and enforcement. Read the guide.
Student Loan Repayment Benefits Under Section 127
Tax-free loan repayment help, now permanent. Read the guide.
PCORI Fee for Employer Health Plans
Who pays, the per-life rate and the July 31 deadline. Read the guide.
RxDC Prescription Drug Reporting for Employer Plans
The June 1 prescription drug and spending report. Read the guide.
Gag Clause Prohibition and the Annual Attestation
The December 31 attestation and the contracts behind it. Read the guide.
FSA, HRA and HSA Coordination for Employers
Which combinations keep HSA eligibility, plus 2026 limits. Read the guide.
Controlled Group Rules for ACA Employer Counts
How related companies are counted for the 50-employee test. Read the guide.
Cannabis and Drug Testing Policies for Michigan Employers
What Michigan law says about employer drug policies. Read the guide.
AI in Employee Benefits Administration
Fiduciary, HIPAA and Section 1557 questions for vendors. Read the guide.
Dependent Care Assistance Programs Under Section 129
The $7,500 limit, written plan and nondiscrimination tests. Read the guide.
W-2 Box 12 Code DD: Reporting the Cost of Health Coverage
Why the Box 12 figure is informational and who has relief. Read the guide.
SMM and SAR Deadlines for Employer Health Plans
The 210-day SMM rule and nine-month SAR rule. Read the guide.
Opt-Out Payments and ACA Affordability
How Notice 2015-87 treats opt-out payments and flex credits. Read the guide.
HSA Comparability Rules for Employer Contributions
The 35% excise tax and how cafeteria plans change the rules. Read the guide.
Excepted Benefit HRAs for Employers
The 2026 limit of $2,200 and what the account can reimburse. Read the guide.
Medicare Enrollment and HSA Contributions
Why the HSA limit is zero once Medicare starts. Read the guide.
Employer Payment Plans and Individual Market Premiums
Why reimbursing individual premiums can trigger a daily excise tax. Read the guide.
Health FSA Carryover, Grace Period, and Run-Out
Carryover, grace period, and run-out rules for health FSAs.
Adoption Assistance Programs Under Section 137
Section 137 limits, payroll treatment, and W-2 reporting.
Group-Term Life Imputed Income Under Section 79
The $50,000 exclusion, Table 2-2 rates, and W-2 code C.
Copay Accumulators and Maximizers in Employer Plans
How accumulators and maximizers work and where the federal rules stand.
HSA Last-Month Rule, Testing Period, and Excess Contributions
The last-month rule, the 12-month testing period, and fixing excess contributions.
ACA Affordability Safe Harbors Explained
The W-2, rate of pay, and poverty line tests and the 2026 percentage.
Group Health Coverage for Owner and Spouse Only Businesses
Why owner-and-spouse-only businesses generally cannot buy group coverage, and what changes with the first employee.
Gender-Affirming Care Coverage in Employer Health Plans
The legal framework and the plan design decisions employers document.
Small Business Health Care Tax Credit (Section 45R)
Who qualifies for the Section 45R small business health care tax credit, the 50 and 35 percent credit rates, t.
How Small Group Premiums Are Rated
The four permitted rating factors for small group health insurance: family tier, rating area, age with its 3 t.
Plain-English Guides to the Documents and Benefits People Ask About
Short explainers on the forms, statements and benefits that come up most often. Each one says what it is, who is responsible and what to do next.
Summary of Benefits and Coverage (SBC)
The standard summary every group health plan must provide, when you get one and who is responsible. Read the guide →
Summary Plan Description vs. Benefits Guide
Why a benefits guide and a carrier certificate are not the plan’s legal document, and what goes wrong. Read the guide →
Explanation of Benefits (EOB)
What it is, how to read it, where to find one and why it is not a bill. Read the guide →
Subrogation Form and Process
Who pays after an injury that was not your fault, and what the form is for. Read the guide →
Reimbursement Request Form
When a plan asks for a reimbursement request and how to complete one. Read the guide →
Form 1095-B for Health Coverage
What the form reports, who receives it and what to do with it. Read the guide →
Proof of Qualified Health Coverage
What counts as proof of coverage and how to get it. Read the guide →
Letter of Eligibility for Group Coverage
What the letter confirms, when it is needed and who issues it. Read the guide →
Referrals and Prior Authorizations
How the two differ, who handles them and what to do when one is missing. Read the guide →
Teladoc Health Explained for Employers
What it covers, how it reaches employees, and where it saves time and money. Read the guide →
IVF and Fertility Coverage
What an employer plan does and does not cover, and what Michigan and federal law say. Read the guide →
LASIK and Laser Vision Correction
What health and vision plans cover, and how HSA and FSA funds apply. Read the guide →
Short-Term Disability Insurance
What it covers, how it pays, how it is taxed and what to ask carriers. Read the guide →
Long-Term Disability Insurance
Definitions of disability, offsets, benefit periods, taxes and what to ask carriers. Read the guide →
Disability Plan Coordination
How STD, LTD, FMLA, Social Security and workers’ compensation fit together. Read the guide →
The ones that do not fit under a single heading
Ten questions employers bring us that cut across every topic on this page.
We have never really looked at our benefits. Where do we start?
With four documents, not a strategy session. Your current plan documents, the last two renewal letters, your rate exhibit, and whatever is running enrollment. Almost every useful question is answerable from those, and almost none are answerable without them. The first read is not about changing anything - it is about finding out what you currently have, which is more often unknown than people expect.
How do we budget for next year before we have a renewal number?
Build it from three pieces rather than one percentage. Start with the carrier's filed increase for your market as the floor, add or subtract for what your own claims experience will carry at your size, then layer in what you already know is changing - headcount, a plan design decision you have deferred, a contribution shift. A single blended guess is what produces the January surprise; a budget with three named components can be defended and corrected.
Our employees say the plan is bad and the data says it is fine. Who is right?
Usually both, because they are measuring different things. The data measures cost and coverage; employees experience deductibles at the pharmacy counter, a denied claim, a provider who left the network, and how long it took to get an answer. A plan can be statistically competitive and still feel punishing at the point of use. When the two disagree, the gap is normally in communication, network fit or claims support rather than in plan design.
How do I make a benefits case to a CFO?
In the language of the rest of the business. Show the decision as a range rather than a number, name what each option does to next year's run rate, and be explicit about which risks you are buying down and which you are choosing to carry. Finance rarely objects to spending on benefits; it objects to spending it cannot forecast. A proposal that shows its own downside gets a better hearing than one that only shows savings.
We are acquiring a company. What happens to their plan?
It depends on the deal structure, and that question needs asking early rather than at closing. An asset purchase and a stock purchase produce very different answers about whose plan continues, who owns the COBRA obligation for people who already left, and what happens to accumulated deductibles mid-year. Controlled-group rules can also pull the acquired entity into your own reporting. The expensive version of this is discovering it in month two.
Our workforce has changed shape. What breaks first?
Eligibility. Whatever moved - more part-time, more remote, more seasonal, more contractors - the first thing to fail is the rule that decides who is offered coverage and when. At the same time, hours-tracking assumptions that were safe with a stable workforce stop being safe, employees in new states bring notice and continuation rules with them, and a plan designed for one population starts getting used by another. The claims consequences show up later; the administrative ones show up immediately.
Should we spend more on the plan or raise pay?
Whichever your people are actually asking for, which is worth finding out rather than assuming. Pay is universally valued and fully taxable. Benefit dollars are narrower but buy more per dollar because of the tax treatment and the group purchasing behind them, and they matter disproportionately to the people most likely to leave over a medical bill. The honest answer is that the mix differs by workforce, and a plan that is generous in ways nobody values is the most expensive outcome of all.
What does a benefits program that is working actually look like?
Cost that moves predictably rather than dramatically. Renewals that are explained before they arrive. Enrollment that finishes without a scramble. Claims problems that get resolved without reaching the CFO. Compliance dates that pass without anyone noticing. Notice that none of that is about having the richest plan - a program is working when it stops producing surprises, and surprises are the thing that actually costs money.
Who inside our company should be in the room for these decisions?
Fewer people than a committee and more than one. Realistically: whoever owns HR, whoever owns the budget, and whoever owns the payroll or HRIS system - because most benefits decisions become an eligibility and data problem before they become anything else. The seat most often missing is the last one, which is how a plan gets chosen in the spring and fails to load correctly in the autumn.
How much of what we read about benefits applies to an employer our size?
Less than it appears. A great deal of published benefits commentary describes very large employers, where the funding, the vendor set and the bargaining position are different in kind rather than in degree. Captives, point solutions and pharmacy carve-outs are real options, but they have size thresholds, and reading about them as though they were universally available is how mid-market employers end up chasing something that does not exist for them yet. The first question to ask of any benefits idea is what size employer it was written for.
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General information about employer benefits programs, not legal or tax advice. Plan-specific questions belong with ERISA counsel, and we will bring them in.
Related guides.
Employer Benefits Questions by Topic
Short answers on COBRA, enrollment, renewals, funding and compliance.
Employer Benefits Compliance Updates
What changed in the rules and what to do next.
Employer Benefits Briefings and Guides
Short written briefings on dates, limits, renewals and plan documents.
Employer Benefits Guides
Plain-language guides on eligibility, plan design, life events and rules.
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.
Where the Rules Come From.
The laws and rules named on this page link to the statute or regulation they come from. This is general information, not legal or tax advice, and rules change, so check the current text.
ERISA (29 U.S.C. Chapter 18)
The federal law that sets reporting, disclosure and fiduciary rules for employer-sponsored benefit plans.
COBRA Continuation Coverage (29 U.S.C. 1161)
Requires many group health plans to offer temporary continuation coverage after a qualifying event.
Affordable Care Act (Public Law 111-148)
The 2010 health reform law, with later amendments, behind employer coverage, reporting and market rules.
ACA Reporting (26 U.S.C. 6056)
The statute behind employer reporting of offers of coverage on Forms 1094-C and 1095-C.
HIPAA Privacy Rule (45 CFR Part 164)
Federal privacy and security standards for protected health information held by health plans.
Family and Medical Leave Act (29 U.S.C. Chapter 28)
Job-protected leave and group health coverage continuation for eligible employees.
Mental Health Parity (29 U.S.C. 1185a)
Parity rules for mental health and substance use disorder benefits in group health plans.
No Surprises Act (Public Law 116-260, Division BB)
Limits surprise out-of-network bills and sets related plan transparency rules.
Cafeteria Plans (26 U.S.C. 125)
The tax code section that lets employees pay certain benefit premiums before tax.
Health Savings Accounts (26 U.S.C. 223)
Tax rules for health savings accounts paired with qualifying high-deductible health plans.
Plan Reporting (29 CFR Part 2520)
The Department of Labor rules for annual plan reports, including Form 5500.
Americans with Disabilities Act (42 U.S.C. Chapter 126)
Prohibits disability discrimination in employment and other areas.
Genetic Information Nondiscrimination Act (42 U.S.C. Chapter 21F)
Limits use of genetic information by group health plans and employers.
Creditable Prescription Coverage (42 CFR 423.56)
Defines creditable coverage for Medicare Part D disclosure and notice rules.
Michigan Earned Sick Time Act (MCL 408.961)
Michigan law on paid sick time accrual, use and notice.
Elliott-Larsen Civil Rights Act (MCL 37.2101)
Michigan’s civil rights law covering employment discrimination.
Publicly Funded Health Insurance Contribution Act (MCL 15.561)
Michigan’s public-employer cap on health plan costs, known as Public Act 152 of 2011.
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