Plan document and SPD
A written plan document and a summary plan description given to participants. The carrier booklet alone is not a plan document, which surprises most employers.
Employer and protection
Group employee benefits
Medical, dental, vision, life and disability for 2 to 500 employees, quoted from a census across every carrier we hold an appointment with.
- Who it suits
- Employers
- Carriers shopped
- The whole panel
- Cost to you
- $0
Overview
What this line actually does
A group medical plan is the single largest benefit line most Ohio employers buy, and it is priced on facts you already have: how many employees, how old they are, where they live, who they cover and what they have today. That is a census, and it is where every honest group quote starts.
We are independent. We do not sit on one carrier's paper and we are not paid more for placing you with one company over another. Our compensation comes from the carrier you choose, at the same schedule regardless of which one that is, which is why a Meridian engagement costs an employer nothing.
Groups under 50 full-time equivalents in Ohio are community rated on age and geography, so the census drives everything. Groups at or over 50 move into the employer mandate and, usually, into experience-rated or level-funded territory where claims history matters. We work both sides of that line every renewal season.
How it works
From first call to in force
Census in
Employee ages, dependent tiers, home ZIP codes and your current plan summary. No names needed for a first look.
Market shop
We run the census through every carrier on our panel and pull rates for a matched benefit design plus two alternates.
Model the split
We show what each employer contribution tier does to your monthly cost and to the employee's payroll deduction.
Compliance check
FTE count, affordability safe harbour and minimum value, so nothing is a surprise in January.
Decide and enroll
You pick. We handle carrier paperwork, enrollment meetings and the employee questions that follow.
What moves the number
Cost factors
| Factor | Why it matters |
|---|---|
| Group size | Under 50 FTEs is community rated on age and ZIP. At 50 and over, claims experience and the employer mandate both apply. |
| Age distribution | Community rating uses each employee's age, so a census skewed older prices higher even with identical benefits. |
| Geography | Rates are set by rating area. A Columbus-based group with remote staff in three states prices differently than one in a single county. |
| Participation | Most carriers want 50% to 75% of eligible employees enrolled, excluding those with other coverage. |
| Employer contribution | Carriers typically require at least 50% of the employee-only premium. Higher contributions raise participation and lower adverse selection. |
| Funding model | Level-funded returns surplus in a good claims year but requires underwriting. Fully insured is predictable and simpler to leave. |
Scroll the table sideways to see every column.
Funding
Three ways to carry the risk
The funding model decides who keeps the surplus in a good claims year, who absorbs a bad one, and how much data you ever get to see about your own plan.
| Question | Fully insured | Level funded | Self funded + stop-loss |
|---|---|---|---|
| Who carries claims risk | The carrier | Shared, with a claims corridor | The employer, above the stop-loss point |
| Monthly cash flow | Fixed premium | Fixed monthly, reconciled annually | Variable: fixed costs plus actual claims |
| Surplus if claims run low | Kept by the carrier | Partially refunded to the employer | Stays with the employer |
| Data you receive | Minimal, usually aggregate only | Aggregate claims and utilisation reporting | Detailed claims data, subject to privacy rules |
| Underwriting to enter | None for small groups | Health questionnaire or claims review | Full medical underwriting |
| Typical group size | 2 to 100 | 15 to 250 | 100 and above |
| Ease of leaving | Simple at renewal | Moderate, watch run-out claims | Complex, run-out and terminal liability |
Scroll the table sideways to see every column.
Affordability
Three safe harbours, one test
Affordability is measured against household income, which no employer knows. The safe harbours exist so you can use something you do know instead. The percentage itself is indexed and changes annually, so we check it against the current figure each renewal.
W-2 Box 1 wages
The employee's required annual contribution for the lowest-cost self-only minimum-value plan is compared to their Form W-2 Box 1 wages for the year.
Accurate and defensible for stable salaried staff.
You do not know the final figure until the year has ended, which makes plan design a forecast.
Rate of pay
Hourly rate multiplied by 130 hours a month, or monthly salary, compared against the required contribution.
Knowable in advance, easy to administer, works well for hourly workforces.
A pay cut mid-year can break the safe harbour for that employee.
Federal poverty line
The required contribution is compared against the federal poverty line for a single individual, indexed annually.
One number for the whole workforce and the safest to defend.
Usually the most expensive, because it caps contributions at the lowest of the three.
Affordability percentages and penalty amounts are indexed and change annually. Not legal or tax advice.
ERISA basics
The paperwork that exists whether or not you know it
Sponsoring a group health plan creates obligations beyond paying the premium. None of them are difficult once they are set up, and all of them are unpleasant to reconstruct later.
Form 5500
Annual filing for plans that meet the participant thresholds. Small fully insured plans are often exempt, but the exemption is narrower than people assume.
Fiduciary duty
Plan assets and participant contributions must be handled for the exclusive benefit of participants. Holding deductions in the operating account is not that.
Required notices
Summary of Benefits and Coverage, COBRA notices, CHIP notice, Women's Health and Cancer Rights, and the Medicare Part D creditable coverage notice each autumn.
Claims and appeals
Written procedures with defined timeframes, plus an external review route for adverse benefit determinations.
Record retention
Keep plan documents, notices, waivers and filings. Reconstructing them after the fact is the expensive version.
Open enrollment
We run the meetings, not your HR manager
Enrollment season is where a good plan design either lands or does not. We do the sessions, the kits and the week-two questions so your team is not the only help desk in the building.
- Sessions across the shift pattern. Two or three meetings per site so the third shift is not handed a leaflet, plus evening slots where the roster needs them.
- English and Spanish. Bilingual sessions run by our own advisors, not a phone interpreter, with the enrollment kit produced in both languages.
- A kit employees take home. Plain-language summary, the deduction table for every tier, the network check instructions, and a direct number for the desk.
- Webinar for remote staff. Recorded and shared, so the person in another state gets the same session as the people in the room.
- Payroll file coordination. Deduction schedules and enrollment files handed to your payroll provider in their format, not ours.
- A named advisor in week two. Because the questions arrive after enrollment closes, not during it. HR should not be the only help desk.
Contribution models
What your employer share does to everyone's costWhat an employer share means on your pay stub
Carriers require at least 50% of the employee-only premium. What you should contribute is a different question, because the split decides participation, participation decides your risk pool, and your risk pool decides next year's renewal.
If you have an employer offer, this is the arithmetic behind your payroll deduction. Employers almost always contribute against the employee-only premium, which is why adding a spouse or children costs so much more than the headline figure suggests.
Enrollment tier
Illustrative monthly premiums. Your rates come from a carrier quote on your own census.
50%50% of employee-only
The carrier floor. Most Ohio carriers will not issue below this.
- Employer pays, per enrolled employee
- $306/mo
- Employee pays
- $306/mo
- Per pay period (24 pays)
- $153.00
Cheapest for the company and the hardest to hold participation with. Younger and lower-paid staff waive first, which ages the enrolled pool and raises next year's renewal.
Expect participation near the 50% to 60% band. Quotable, but tight.
Most placed
75%75% of employee-only
The most common design we place for 10 to 100 life groups.
- Employer pays, per enrolled employee
- $459/mo
- Employee pays
- $153/mo
- Per pay period (24 pays)
- $76.50
Enough employer share that waiving stops being the obvious choice. Participation usually clears carrier minimums comfortably and the enrolled pool stays balanced.
Typically 70% to 85% participation. Full market access.
100%100% of employee-only
A recruiting position, common in professional services and trades competing for staff.
- Employer pays, per enrolled employee
- $612/mo
- Employee pays
- $0/mo
- Per pay period (24 pays)
- $0.00
Employee-only coverage costs the employee nothing, so near-universal take-up follows. Dependent cost becomes the whole conversation, and that is where design work moves next.
Participation above 90% is normal. Best available rates.
Employer contribution is applied to the employee-only premium of $612 per month, which is how the great majority of Ohio small group plans are designed.
What participation does to your options
- Below 25%Not quotable
No carrier on our panel will issue a group plan at this level. Below a quarter of eligible employees enrolled, the pool is assumed to be only the people who expect claims.
- 25% to 49%Rarely quotable
A small number of carriers will look at this with a strong employer contribution and a clean industry code, usually with a rate load. Plan on fixing participation first.
- 50% to 74%Quotable
The standard minimum. Most carriers accept 50% or more of eligible employees enrolled, after valid waivers are removed from the count.
- 75% and aboveFull market access
Every carrier on the panel will quote, including the level-funded programmes that decline thinner groups. This is where the best pricing sits.
Waivers that come out of the count
- Covered by a spouse's employer plan
- Covered by a parent's plan (under 26)
- Enrolled in Medicare Part A and Part B
- Active TRICARE or VA coverage
- Covered by Medicaid or a state plan
Waivers that do not
- Declined because the payroll deduction is unaffordable
- Declined with no other coverage at all
- Enrolled in an individual Marketplace plan instead
Our fee, in full
$0. Employers pay no broker fee and individuals pay no consultation fee. We are compensated by the carrier you select, on a schedule that does not vary between the carriers on our panel, which is why we can tell you to stay where you are.
Employer mandate
Counting to fifty
The applicable large employer test decides whether you have a coverage obligation at all. It is a look-back over last year, full time means 30 hours rather than 40, and part-time hours roll up into equivalents. Here is the whole thing in plain language.
50full-time equivalents, averaged across the prior calendar year and rounded down
Affordability and minimum valueThe 50 full-time equivalent line
It is a look-back, not a snapshot.
The rule, and what to watch
An employer that averaged 50 or more full-time equivalent employees across the prior calendar year is an applicable large employer (ALE) for the current year.
The count is averaged over twelve months and rounded down. Crossing 50 in three busy months does not automatically make you an ALE.
What counts as full time
Thirty hours, not forty.
The rule, and what to watch
A full-time employee averages 30 or more hours of service per week, or 130 hours of service in a calendar month.
Hours of service include paid leave, holiday and jury duty, not just hours worked at the bench.
How part-time hours roll up
Part-timers do not count as zero.
The rule, and what to watch
Add every part-time employee's hours of service for the month, cap each individual at 120, divide the total by 120, and drop the fraction. Add that to your full-time headcount.
Worked through: 38 full-time employees plus 22 part-timers averaging 65 hours a month gives 38 + (1,430 / 120 = 11.9 → 11) = 49 FTEs. Not an ALE, by one.
Common ownership is aggregated
Three restaurants under one ownership group with 20 staff each are not three small employers.
The rule, and what to watch
Businesses under common control are treated as one employer for the ALE count, even when they file separately and run separate payrolls.
This is where multi-entity owners get caught. Aggregation applies to the count; the offer and any penalty apply at the individual entity level.
The seasonal worker exception
Landscaping, agriculture, holiday retail and summer camps use this.
The rule, and what to watch
If you exceed 50 FTEs for 120 days or fewer in a calendar year, and the employees above 50 in that period were seasonal workers, you may not be an ALE.
120 days, or four calendar months, need not be consecutive. Document the seasonal roles before you rely on this.
The offer requirement
Dependent children means to age 26.
The rule, and what to watch
An ALE must offer minimum essential coverage to at least 95% of its full-time employees and their dependent children, or face a penalty if any full-time employee receives a premium tax credit.
This is the larger of the two penalties and it applies across the whole full-time workforce, not only to the employee who claimed the credit.
The affordability test
Nobody knows an employee's household income, so the rules give three safe harbours you can use instead: the employee's W-2 Box 1 wages, their rate of pay, or the federal poverty line..
The rule, and what to watch
The employee's required contribution for the lowest-cost, self-only, minimum-value plan must not exceed the indexed affordability percentage of household income.
The percentage is indexed annually. Rate of pay is the easiest to administer; federal poverty line is the safest but usually the most expensive.
The minimum value test
Sixty percent actuarial value is roughly a Bronze-level plan.
The rule, and what to watch
A plan provides minimum value if it pays at least 60% of the total allowed cost of benefits and offers substantial coverage of inpatient hospital and physician services.
Minimum essential coverage and minimum value are different tests. A plan can satisfy the first and fail the second.
Reporting follows the offer
The codes are where most penalty notices come from.
The rule, and what to watch
ALEs file Forms 1094-C and 1095-C each year, coding every full-time employee month by month for what was offered and what it cost.
Keep the offer evidence, the waiver forms and the contribution history. Reconstructing a year of codes from memory in March is not possible.
Thresholds are indexed and change annually. Not legal or tax advice.
Renewal season
A 150-day working calendar
Renewals are decided long before the anniversary letter arrives. Start at 30 days and the incumbent already knows you cannot move.
150 days out
Data pull
Refresh the census, confirm the FTE count and pull twelve months of claims or utilisation where the funding model gives us any.
120 days out
Market shop
Quote the incumbent design plus two alternates across the panel, including level-funded where the group qualifies.
90 days out
Design and split
Model contribution tiers against participation and show the employee payroll impact of each.
60 days out
Decision
Employer selects. We handle carrier paperwork, plan documents and the payroll file.
30 days out
Enrollment
Meetings on site or by webinar, English and Spanish, plus a plain-language kit for employees to take home.
Day 1
Go live
ID cards, payroll deduction confirmed, and a named advisor for the questions that always arrive in week two.
Enrollment windows
The dates that actually bind
Medicare runs on hard deadlines and two of them never come back. Here is the whole calendar in order.
3 months before 65
Initial Enrollment Period opens
Seven months wide: three before your birthday month, the month itself, three after. Enrolling early avoids a gap.
Turning 65
Part B decision
Delay it without penalty only if you have creditable employer coverage from active employment.
Within 6 months of Part B
Medigap open enrollment
The one window where no Medicare Supplement carrier can turn you down or surcharge you for health.
Oct 15 to Dec 7
Annual Election Period
Change Advantage or Part D plans for a January 1 start. Formularies change every year, so this is a real review, not a formality.
Jan 1 to Mar 31
Advantage Open Enrollment
If you are already in a Medicare Advantage plan, one change is permitted in this window.
Any qualifying event
Special Enrollment Period
A move, losing employer coverage, or a change in assistance status can open a window outside the usual dates.
Related lines
Often looked at alongside this
Life insuranceTerm, permanent and employer group life, sized against the obligations that would actually remain if someone did not come home.Open Dental, vision and hearingStandalone and employer-sponsored ancillary cover, where annual maximums and waiting periods matter more than the monthly premium.Open Critical illness and supplementalAccident, hospital indemnity and critical illness policies that pay cash directly to you, sized against a real deductible rather than sold as a catch-all.Open
Before you decide
Group benefits questions we hear most
If your question is not here, call the desk. Nobody will put you on a list for asking.
In Ohio, a group can be as small as two enrolled employees, though some carriers set their own floor. Sole proprietors with no W-2 employees are generally an individual or self-employed case rather than a group.
Nothing. We are compensated by the carrier you place with, on a schedule that does not vary by carrier. There is no broker fee, no consulting retainer and no charge for the census analysis.
Often yes. A market shop frequently ends with a renegotiated renewal at the incumbent. Knowing what the rest of the market offered is what makes that conversation work.
A first-pass comparison from a clean census usually takes two to four business days. Level-funded and self-funded options need medical underwriting, which adds one to two weeks.
Yes, on site or by webinar, including evening shifts and bilingual sessions. We also leave a plain-language enrollment kit so employees can read it at home.
Bring us the file. We will bring the market.
Send a census or ask one question. Either way it costs you nothing and nobody will chase you.
Independent and multi-carrier. $0 cost to work with us. No pressure scripts.