Six settings make up a first plan.
Every quote you compare is some mix of these.
- Who is eligible: full-time only, or part-time too, written as a rule
- When coverage starts: a waiting period of no more than 90 days
- What the company pays: a share of employee-only premium, and whether any reaches dependents
- Which network: one that includes the clinics your people already use
- How much risk employees carry: deductible, copays and out-of-pocket limit
- What sits beside medical: dental, vision, life or employee-paid voluntary coverage
To begin, all you need is a monthly budget and a start date in mind. No existing plan, benefits staff or finished wish list required.
Rules still apply once you start. The ACA's employer requirements reach businesses that averaged 50 or more full-time and full-time-equivalent employees over the prior calendar year, and smaller employers still take on plan, contract and state obligations when they offer coverage. Whatever you choose, write the eligibility and contribution rules down and follow them.
Four levers that set the monthly number.
Contribution: start with employee-only
Fund part of each employee's own premium first, dependents second.
Dependent tiers are where first-year budgets break. A common starting design pays a set share of employee-only coverage and leaves the cost of covering a spouse or children to the employee, through payroll.
Illustrative: if employee-only coverage quotes at $700 a month and the company funds 60%, the company pays $420 and the employee pays $280. Family tiers, pay frequency and vendor fees each need a separate calculation.
One plan or two
One plan is easier to explain. Two let employees choose their tradeoff.
Pairing an HSA-qualified high-deductible plan with a copay plan gives employees a lower-premium option without forcing it on anyone, but it doubles what you explain at enrollment. See one health plan or two for setting contributions when there's a choice.
Fully insured or level-funded
Small-group pricing ignores health history. Level-funded pricing doesn't.
Washington small-group rates can vary only by geographic area, family size, age and wellness activities, so a first quote reflects who you employ and where. A level-funded plan is underwritten on your own group: one fixed monthly payment covers a claims fund, stop-loss insurance and administration, and a surplus refund is possible, not promised. Underwriting can also raise the price or decline the group, so we quote both.
No group plan yet
A QSEHRA reimburses individual coverage instead.
An employer under 50 with no group health plan can offer a QSEHRA, capped for 2026 at $6,450 self-only and $13,100 family, with written notice due at least 90 days before the year. Stand-alone group dental, vision or a health FSA count as group health plans, so none of them can sit beside it. Run the ICHRA and QSEHRA employee cost test before you commit.
Working back from the first day of coverage.
About four months out: budget and eligibility
Pick a monthly number the company can carry for a full plan year, and decide who qualifies. If a QSEHRA is in the running, decide now: its notice is due at least 90 days before the year.
About three months out: census and quotes
Send ages, home ZIP codes and coverage tiers through our census page. We quote Premera Blue Cross, Regence BlueShield, Asuris Northwest Health, Kaiser Permanente and UnitedHealthcare, plus level-funded plans from UnitedHealthcare, Nationwide, Angle Health and Cigna where the group fits.
About two months out: choose and document
Pick the plan or plans, set contributions by class, and write down eligibility and the waiting period. The carrier's paperwork deadline sets the real date, and we confirm it.
About one month out: enroll
We run enrollment education in groups, one on one or by live video, at no extra fee for client teams. Group clients who want Employee Navigator get it customized at no extra cost.
First payroll: check the deductions
Match the first deductions to the elections and the first carrier invoice. Mismatches are a quick fix in month one.
What we need now, and what can wait.
Send now
Headcount, which employees you plan to cover, work locations, a target start date, a monthly budget range, and a census when you have one. No current plan is needed.
Decide later
Dental, vision, life and voluntary coverage can follow once medical is settled. Voluntary plans are employee-paid through payroll deduction, and none of these replace medical insurance.
What first-time employers ask us.
Are we required to offer health insurance?
Not if you're under 50. Federal law doesn't require it below that size, and Washington adds no employer mandate. Once you average 50 or more full-time and full-time-equivalent employees over a calendar year, the ACA employer rules apply the following year. Our full-time equivalent calculator runs the count.
Can we cover full-time staff and leave part-time staff out?
That's a common design. The rule has to be written, applied the same way to everyone it describes, and allowed under the carrier's eligibility terms, which we check with each quote. Owner eligibility depends on the entity and the plan, so we confirm that too.
How long can new hires wait for coverage?
Up to 90 days, the federal cap. A short wait helps recruiting, and a longer one keeps coverage off roles that turn over in the first few weeks. Choose one and apply it to every new hire in the class.
Should dental and vision start on day one?
Only if the budget still works after medical. Either can start with medical or join at a later renewal. One catch: a stand-alone group dental or vision plan counts as a group health plan, which rules out a QSEHRA.
Official references.
IRS: determining applicable large employer status. IRS: identifying full-time employees. Washington OIC: small business health plan options. General information, not legal or tax advice.
Price a first plan before you promise one.
Share your headcount, locations, budget range and preferred start date. The quote is no obligation, and you don't need a plan in place today.