Large group health insurance in Missouri

Large group health insurance is a different market from the one small businesses shop in. The ACA's standardized small group rules fall away, carriers price your group on its own history, and the menu of funding options gets wider. That flexibility can save a lot of money, or cost a lot, depending on how well your plan is matched to your workforce.

Group Health Missouri works with employers from just over 50 employees up to several hundred. We are independent, so we compare carriers and funding models side by side instead of renewing whatever is on the table.

Three ways to fund a large group plan

Fully insured

You pay a fixed premium and the carrier takes on the claims risk. Budgeting is simple, and your renewal reflects both your claims and the carrier's trend. This is the default for many groups in the 51 to 150 range.

Level-funded

You pay a steady monthly amount that covers expected claims, administration and stop-loss insurance. If claims come in under budget, part of the surplus may come back to you or roll into next year, depending on the contract. Level funding has grown popular with healthier groups that want fully insured predictability with some upside.

Self-funded

The business pays claims as they happen, with a third-party administrator running the plan and stop-loss coverage capping catastrophic claims. Self-funding gives the most control over plan design and the most transparency into where dollars go, along with the most cash-flow swing. It usually fits groups of 100 or more best.

What changes when you cross 50

• Experience rating. Your claims, demographics and industry set your price, so claims reporting becomes a negotiating tool.
• The employer mandate. Employers with 50 or more full-time employees, including full-time equivalents, are applicable large employers under the ACA and must offer affordable, minimum-value coverage or risk a penalty.
• Annual reporting. Applicable large employers file Forms 1094-C and 1095-C each year. We coordinate with your payroll provider so the data lines up.
• Federal COBRA. Employers with 20 or more employees follow federal COBRA continuation rules instead of Missouri's state continuation law.

Networks across a Missouri workforce

Large employers rarely have everyone in one metro. A distribution company might have a warehouse in Kansas City, a sales office in St. Louis and drivers living in small towns across the state. Carrier networks are built around hospital systems such as BJC Health System, SSM Health, Mercy, CoxHealth, MU Health Care and University Health, and no single network is equally deep everywhere. We map where your employees actually live against each carrier's network before you choose.

How we run a large group renewal

1. Request 12 to 24 months of claims and enrollment data from your current carrier.
2. Review large claims, plan usage and pharmacy spend to find what is driving cost.
3. Market the group to fully insured, level-funded and self-funded options as appropriate.
4. Negotiate with your incumbent using competing offers, then lay out the choices in plain numbers.
5. Handle enrollment, employee communication and compliance filings once you decide.

Smaller and still under 51? See small business health insurance. Want the plan design background first? Our plan types guide covers PPO, HMO and HSA plans.