The large group health plan market is the single largest category of health insurance in the nation. In most states, an employer qualifies for large group coverage with at least 51 eligible employees, though in a handful of states that threshold is 101. Association health plans are an instrument by which employers with 50 or fewer employees can access the large group market. Among the advantages of the large group market is the potential for paying lower costs for the same benefits received in the small group market.
Group health insurance operates under different regulations and benefit requirements depending on whether it is a “small group” plan or a “large group” plan. Small group plans operate under the requirements of the Affordable Care Act, which include 10 categories of mandated benefits. Large group plans, in contrast, have more flexibility regarding what benefits they include within their plan, though there are some benefits that are mandated. For plans that are self-insured (otherwise known as self-funded), benefit requirements may differ further.
