When offering health insurance, one of the first questions business owners face is: Am I a small group or a large group? It might seem like a simple label, but this distinction can impact everything from your plan design and pricing to compliance requirements and penalties.
And here’s the catch: the answer isn’t the same in every state.
In most of the U.S., businesses with 50 or fewer full-time equivalent (FTE) employees are considered small groups. Those with 51 or more are large groups. However, states like California, Colorado, New York, and Vermont set that threshold at 100 employees, making it even more important to understand how your state defines your group size.
Why it matters
- Plan Flexibility
Large groups can negotiate more tailored plans. Small groups must offer ACA-mandated essential benefits and often have fewer customization options. - Premium Pricing
Small group premiums are based on community factors like age and location. Large group plans are priced based on your specific claims history, which can work for or against you. - Compliance Rules
Large group employers face more complex ACA requirements, including offering affordable coverage or paying steep penalties.
Why PT Business Solutions?
This is where the real advantage of working with PT Business Solutions comes in. We don’t just help you choose a plan—we help you make a strategy.
Whether you’re on the edge of crossing into large group territory or simply trying to get smarter about your benefits, our team evaluates your workforce, guides you through your group size designation, and helps you build a plan that supports your people and protects your business.
At PT Business Solutions, we help you navigate every step of the process:
- Understand your group size (it’s trickier than it sounds)
Group size isn’t just about how many people are on payroll. It includes full-time equivalent (FTE) calculations, variable-hour employees, and can even be impacted by seasonal or part-time staff. Plus, thresholds differ by state. We take the guesswork out of it, analyzing your workforce structure and ensuring you’re accurately categorized under state and federal guidelines. - Stay compliant with federal and state-specific regulations
The compliance landscape is complex and constantly changing, from ACA mandates and IRS reporting to COBRA continuation and state-level nuances. We build compliance into every step of your benefits strategy to keep you up to date, audit-ready, and penalty-free. - Compare plan options with fundamental cost-control strategies
We don’t just show you what’s available—we break down the actual cost of each option, help you understand the trade-offs, and identify innovative ways to reduce expenses without compromising coverage. Whether it’s optimizing plan design, evaluating level-funded options, or structuring contributions, we help you make data-backed decisions. - Create benefits that attract and retain top talent
Health insurance is one of the top reasons employees join—and stay with—a company. We help you craft a benefits package that’s competitive, valuable, and aligned with your company culture and goals. The result? Happier teams, improved retention, and stronger recruitment.
At PT Business Solutions, we turn complexity into clarity and ensure your benefits plan works for you.
Let’s simplify the process and get you set up for long-term success.
Schedule a consultation with our team today.
