If your company employs between 50 and 100 people, you are in a category that carries both significant responsibility and real options when it comes to health benefits. The Affordable Care Act’s employer mandate applies to you — employers with 50 or more full-time equivalent employees are required to offer minimum essential coverage or face penalties. But beyond compliance, the decisions you make around health insurance directly affect employee satisfaction, retention, and your company’s bottom line.
The good news: this size range has more plan structures available to it than many HR managers realize. The challenge is figuring out which one actually fits your workforce, your budget, and your risk tolerance — before the next open enrollment deadline arrives.
This guide breaks down the core plan types for businesses your size, what they cost, what to watch for during open enrollment, and how a licensed broker can simplify the entire process.
Your Plan Options as a 50–100 Employee Employer
Fully Insured Group Plans
The most familiar structure: your company contracts with a commercial insurer, pays a fixed monthly premium per employee (and dependent, if applicable), and the insurer assumes all the financial risk for claims. If your workforce has a great year health-wise, you still pay the same premium. If it has a difficult year, the insurer absorbs the excess costs.
Who it works well for: Employers who want cost certainty and minimal administrative overhead. Fully insured plans are straightforward to administer, come with robust carrier support, and are easy for employees to understand.
The tradeoff: You pay for predictability. Premiums are typically higher than what you would pay in a good claims year under a self-funded or level-funded arrangement, and you have no ability to share in the savings if your employees stay healthy.
Cost range in 2026: Following a trend of accelerating increases, employer-sponsored health insurance premiums averaged approximately $27,000 per year for family coverage and around $8,000–$9,000 for single coverage. Employers typically cover 70–80% of the employee-only premium and a lower percentage of dependent coverage. For a team of 75, the annual employer outlay for a fully insured plan commonly runs $1.5 million to $2.5 million depending on plan design, geography, and workforce demographics.
Level-Funded Health Plans
Level-funded plans occupy a middle ground between fully insured and self-funded. Your company pays a fixed monthly amount — the “level” — that covers expected claims, stop-loss insurance, and administration fees. At the end of the plan year, if actual claims come in under the projected amount, you receive a refund of the surplus. If claims exceed projections, your stop-loss coverage kicks in to protect you.
Who it works well for: Employers with a relatively healthy workforce who want the administrative simplicity of a fully insured plan but want some potential upside if claims run low. Level-funded plans have become increasingly popular in the 50–100 employee range because the minimum group size requirements have come down and the stop-loss protection makes the risk manageable.
The tradeoff: You take on more complexity and administrative responsibility than with a fully insured plan. If your workforce demographics shift — more older employees, more chronic conditions — your renewal rates can increase sharply. And the refund potential requires a good claims year to materialize.
Cost range: Level-funded plans typically run 5–15% less in premium outlay than fully insured plans for similarly healthy groups, with stop-loss protection preventing catastrophic exposure. The claims data you accumulate also gives you more transparency and negotiating leverage at renewal.
Self-Funded (Self-Insured) Plans
In a self-funded arrangement, your company assumes direct financial responsibility for employee health claims up to a certain threshold. You pay claims as they come in rather than a fixed monthly premium to a carrier. Stop-loss insurance — typically specific (per-person) and aggregate (total claims) — protects against catastrophic or unexpectedly high claims years.
Who it works well for: Employers with stable, predictable workforces, sufficient cash reserves to absorb claims volatility, and strong administrative capabilities (or a capable third-party administrator). Self-funded plans are more common at the upper end of the 50–100 range and above, where pooling a larger number of employees reduces individual claim volatility.
The tradeoff: This is not a set-it-and-forget-it arrangement. Self-funded employers take on compliance obligations, claims management, and financial exposure between deductible layers. For smaller groups at the lower end of this size range, the risk can be difficult to manage without robust stop-loss protection.
Cost range: The savings potential is real — well-run self-funded plans can cost 10–25% less than fully insured alternatives over time — but the variance is also real. A single high-cost claimant can swing a plan year significantly before stop-loss engages.
ICHRA (Individual Coverage Health Reimbursement Arrangement)
An ICHRA is a different structural approach entirely. Instead of offering a group plan, the employer reimburses employees a defined monthly allowance that employees use to purchase their own individual health insurance — either through the ACA Marketplace or directly from a carrier.
Who it works well for: Employers with geographically dispersed workforces, employees with widely varying coverage needs, or companies that want to define their health benefit costs precisely without being subject to renewal negotiations and carrier pricing. ICHRAs are also a good fit when employees might qualify for ACA Marketplace plans at competitive rates.
The tradeoff: Employees are responsible for selecting and managing their own coverage, which requires more decision-making on their part. The employer must set an allowance high enough to be competitive, and employees in states with limited Marketplace options may have fewer choices than a group plan would provide. There are also affordability rules to navigate — if the ICHRA allowance does not meet the ACA’s affordability standard, affected employees may be eligible for Marketplace subsidies instead of using the reimbursement.
Cost range: The employer defines the budget. Monthly allowances for a 50–100 employee group commonly range from $400–$700 per employee for self-only coverage and $900–$1,400 for family coverage, depending on market conditions and competitive benchmarks in your industry.
What HR Managers Should Watch for During Open Enrollment
Open enrollment is not just a logistical exercise — it is the moment when your plan choices translate into real costs and real coverage for your employees. Here is what to pay close attention to:
1. Renewal Rate Increases — and What Is Driving Them
Employer health costs are projected to rise 8.2% in 2027, the fastest increase in more than two decades. When your renewal comes in, do not accept the rate increase as a given before understanding what is driving it. Carriers factor in your group’s claims history, demographic changes, and market-wide cost trends. A broker can help you determine whether the increase is justified or whether you have leverage to negotiate — or whether it is time to switch carriers or structures.
2. Network and Provider Changes
Carriers restructure their networks regularly, and what was in-network for your employees last year may not be this year. Before finalizing your plan selection:
- Verify that your employees’ primary care physicians, specialists, and preferred hospitals remain in-network
- Check prescription drug formularies — a medication moving to a higher tier can significantly increase out-of-pocket costs for employees
- Confirm mental health and behavioral health provider availability, which is an increasing employee concern
3. Employee Contribution Strategy
As employer costs rise, many companies are increasing employee contributions — through higher paycheck deductions, increased deductibles, or both. Before making changes, model the impact on your lowest-paid employees. Under ACA affordability rules, if an employee’s required contribution for employee-only coverage exceeds a percentage threshold of their household income (approximately 9.02% for 2026), your company may face penalties regardless of whether you technically offered coverage. A benefits advisor can run these calculations before you set contribution levels.
4. Dependent Coverage Participation and Costs
Dependent coverage — particularly for families — is where employer health costs can escalate quickly. Understand what percentage of your employees are electing family coverage and what the employer cost per dependent is. Some employers cap or restructure dependent contributions when costs become disproportionate.
5. Compliance Deadlines and Reporting Requirements
Employers with 50 or more full-time equivalent employees must file IRS Forms 1094-C and 1095-C annually to document that minimum essential coverage was offered. Missing these deadlines or reporting errors can trigger penalties. Work with your benefits team or broker to confirm your reporting obligations and timelines ahead of each plan year.
6. Employee Communication and Decision Support
Your employees make better decisions — and appreciate their benefits more — when they understand their options. Consider providing clear, plain-language benefit summaries, hold a Q&A session before open enrollment closes, and make it easy for employees to ask questions about their specific situations. A broker can participate in employee meetings at no additional cost.
How a Broker Simplifies the Process
Working with a licensed, independent health insurance broker costs you nothing out of pocket — broker compensation is built into carrier premiums and remains the same whether you use a broker or go direct to the carrier. The difference is what you get.
Here is what a broker does for employers in the 50–100 employee range:
- Market analysis across multiple carriers. An independent broker shops your group across fully insured, level-funded, and alternative funding arrangements to find competitive options — not just the products a single carrier wants to sell you.
- Claims and renewal analysis. If you are currently in a level-funded or self-funded arrangement, a broker reviews your claims data alongside the renewal to determine whether the increase is defensible or whether you have alternatives.
- Plan design guidance. Deductible levels, copay structures, HSA eligibility, dependent tiers — these decisions affect both what you pay and how your employees experience their coverage. A broker with employer experience knows which structures work for teams your size.
- Compliance navigation. The employer mandate, affordability thresholds, 1094-C/1095-C filing, ICHRA rules — a broker who specializes in employer benefits can ensure you are meeting your obligations without spending thousands on a benefits attorney for routine guidance.
- Employee communication support. Benefit guides, enrollment meeting facilitation, one-on-one employee questions — a broker extends your HR team’s capacity during open enrollment without adding headcount.
- Ongoing advocacy. When a claim is denied or a billing issue arises mid-year, having a broker in your corner means you have someone to call who knows your plan and can advocate on your behalf with the carrier.
For businesses with 50 to 100 employees, the difference between managing benefits in-house and having a knowledgeable broker is often thousands of dollars in premium savings, fewer compliance headaches, and employees who actually understand what they have.
Is It Time to Review Your Current Structure?
If any of the following apply to your business, it is worth having a conversation about whether your current plan structure is still the right fit:
- Your workforce is aging or you have a significant number of employees approaching Medicare eligibility
- You received a renewal increase of 10% or more
- Employees have been asking questions about why their out-of-pocket costs keep rising
- You recently grew past 50 employees and are figuring out your obligations for the first time
- You are offering a fully insured plan but have a healthy, younger workforce that might benefit from level-funding
Bri is a licensed health insurance specialist serving employers across Arkansas, Arizona, Florida, Georgia, Iowa, Kentucky, Louisiana, Maine, Michigan, Mississippi, North Carolina, Ohio, Oklahoma, and Texas. If your open enrollment is coming up — or if you want to evaluate your options before it does — the conversation is free and there is no obligation.
Book a consultation today and let’s make sure your team has the coverage that actually works for them.