Census re-shop
Send the census and your current plan summary. We run the full panel and return a matched comparison with two alternates.
No cost, no obligation, no requirement to move carriers.
Open through the current renewal season
Send a censusGroup benefits desk, Columbus OHIndividual and Medicare desk, Columbus OH
A benefits desk that runs on your census, not a brochureEvery plan in your county, compared out loud
Independent and multi-carrier. Send your census, get the whole panel priced. It costs your company nothing.
Independent and multi-carrier. We check your doctors and your prescriptions against every plan where you live. It costs you nothing.
Choose your view: employer or individual
- $0 cost to work with us
- 18 carriers on the panel
- Licensed in 11 states
Comparison console
Funding models, side by side
Group funding structures compared.
| 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.
Comparison console
Your three routes, side by side
The three coverage routes compared. Availability varies by county.
| Question | Medicare Advantage | Supplement + Part D | ACA Marketplace |
|---|---|---|---|
| Who is it for | 65+ or qualifying disability | 65+ or qualifying disability | Under 65 without employer cover |
| Provider access | Plan network, referrals common | Any provider accepting Medicare | Plan network, often narrow |
| Monthly cost shape | Low or zero plan premium, copays on use | Higher premium, very low cost at use | Premium after any tax credit, plus deductible |
| Out-of-pocket maximum | Yes, set by the plan | Effectively none needed with Plan G | Yes, set by law each year |
| Drug coverage | Usually built in | Separate Part D plan required | Included in the medical plan |
| Travel and out-of-area | Emergency care only on HMO plans | Works nationwide | Emergency care only on most plans |
| Changing later | Annual windows | May need medical underwriting | Open Enrollment or qualifying event |
Scroll the table sideways to see every column.
11states licensed
18carriers on the panel
$0cost to work with us
6advisors at the desk
Carrier panel
We represent the whole market, not one company
Eighteen carriers on the panel, and no contract that makes us prefer one.
Alderway HealthNorthreach MutualVireon Health PlansSteadhaven LifeQuillon DentalBrookfern VisionHarborlight Benefit Co.Cresswell MutualTallgrass Health AllianceOrrindale AssuranceWrenfield Dental & VisionLumenbrook SupplementalFairmount Health GroupSilverbeck AssuranceElmgate VisionPinegrove DentalRavenwood MutualCastellon Health Partners
At the desk
Three things we do that cost you nothing
Not loss leaders and not a trial. This is the work, and it is included because carriers pay us, not you.
Compliance file review
We walk your FTE count, affordability safe harbour, minimum value and last year's 1095-C coding before a notice arrives.
Typically 45 minutes. Bring your payroll export and your plan summary.
Booked year-round
Book a reviewOpen enrollment meetings
On-site or webinar sessions for your staff, in English and Spanish, with a plain-language kit they can take home.
Evening and shift-friendly sessions available.
Scheduled 30 days before your effective date
See the calendarTurning 65 review
One hour, your doctors and your prescriptions checked against every plan available in your county, with the trade-offs read out.
Bring your Medicare card, your drug list and your provider list.
Available year-round
Book the reviewAutumn drug list re-run
Every October we re-run your prescriptions against next year's formularies, because last year's best plan rarely stays best.
Existing clients are contacted automatically. New clients are welcome.
Runs each Annual Election Period
How it worksSocial Security timing session
A break-even analysis on claiming age using your own earnings record, alongside how the decision interacts with Medicare.
Bring your Social Security statement. No products are sold in this meeting.
Available year-round
See the methodWho we help
Four people, four questions
Find the one that sounds like yours.
Turning 65“Do I have to do anything, and when?”Read the walkthrough
Self-employed“How do I cover myself when the income moves?”Read the walkthrough
Families“How do we cover everyone without overpaying?”Read the walkthrough
Business owners“What should we offer, and what will it cost us?”Read the walkthrough
Directory
The employer control panel
The individual control panel
Eight places to start, each one a real piece of the group benefits problem rather than a brochure page.
Eight entry points across Medicare, the Marketplace and the lines that sit around them.
Census quote intakeAges, dependent tiers, ZIPs and your current plan. The whole group market, priced from one file.2-4business days to first comparisonOpenParticipation and contributionWhat a 50, 75 or 100 percent employer share does to take-up and to the payroll deduction.75%most commonly placed employer shareOpenALE threshold checkThe 50 full-time equivalent line, counted the way the rules actually count it.50full-time equivalentsOpenFunding modelsFully insured, level funded and self funded with stop-loss, compared on risk and cash flow.OpenCarrier network footprintHow HMO, EPO, POS and PPO networks behave when your workforce is spread across county and state lines.OpenRenewal season deskA 150-day working calendar, starting well before the anniversary letter arrives.150days before renewal we startOpenOpen enrollment supportOn-site and webinar meetings, bilingual sessions, and a plain-language kit employees take home.OpenCompliance libraryAffordability safe harbours, minimum value, ERISA plan documents and 1095-C coding, in plain language.OpenTurning 65Your Initial Enrollment Period, what happens if you are still working, and the Medigap window you only get once.7months in your IEPOpenAdvantage or SupplementThe real trade-offs: network, travel, underwriting later and how predictable the cost is.OpenPart D and your drug listTier placement decides your year, not the monthly premium. We run every prescription.OpenACA MarketplaceMetal tiers, advance premium tax credits and the cost-sharing reductions people miss on Silver.OpenSelf-employed cover1099 income, a subsidy that moves with your earnings, and the deduction most people underuse.OpenSocial Security timingA break-even analysis on claiming age, run against your own earnings record.8%per year of delayed creditsOpenDental, vision and hearingAnnual maximums and waiting periods decide the value, not the monthly premium.OpenLife and supplementalSized against the obligations that would actually remain, then shopped across the panel.OpenCensus intake
How a group quote is actually assembled
Six columns, one row per benefits-eligible employee, no names needed for a first look. In the Ohio small group market this file is the quote: rates are built member by member from age, tier and geography.
Per employee
- Age on the effective dateRequired
e.g. 47
Why we ask
Small-group rates in Ohio are built per member from an age curve. This is the single largest rating input.
- Dependent tierRequired
EE / EE+SP / EE+CH / Family
Why we ask
Each tier is rated separately. Spouse and child ages are rated too, up to three children.
- Home ZIP codeRequired
e.g. 43017
Why we ask
Rating area and network access both follow the member's home ZIP, not the office address.
- Current plan or waiver reasonRequired
Enrolled / waived with spouse coverage
Why we ask
Valid waivers come out of the participation denominator. Invalid ones do not.
- Tobacco useHelpful
Yes / No
Why we ask
Permitted as a rating factor in some markets and lines. We ask so the quote is not revised later.
- Employee classHelpful
Salaried / hourly / union
Why we ask
Class carve-outs let you offer different contributions to different groups, within non-discrimination rules.
A census extract
| Ref | Age | Tier | ZIP | Status |
|---|---|---|---|---|
| 001 | 52 | Family | 43017 | Enrolled |
| 002 | 34 | EE only | 43081 | Enrolled |
| 003 | 29 | EE + child(ren) | 43123 | Enrolled |
| 004 | 61 | EE + spouse | 43230 | Enrolled |
| 005 | 45 | EE only | 43054 | Waived - spouse plan |
| 006 | 23 | EE only | 43026 | Waived - parent plan |
Scroll the table sideways to see every column.
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.
Dana WhitfieldManaging partner · Group benefits
Who you will be dealing with
The desk has a name on it
Not a call centre and not a lead form. One advisor, start to finish.
- CBGACertified Benefits & Group Advisor
Dana runs the employer desk and takes the larger renewals herself. She came out of hospital revenue-cycle work, which is why the first thing she asks about any plan is how a claim actually gets paid.
She takes the larger renewals herself and hands nothing to a junior desk halfway through. If she cannot beat what you already have, she will tell you that too.
- Groups of 50 to 250
- Level-funded transitions
- Renewal negotiation
How it works
Three steps, and none of them cost you
Start to finish, usually inside a fortnight.
Send the census
Ages, dependent tiers, ZIP codes and your current plan summary.
We shop the panel
Every carrier, your design matched plus two alternates, priced on your own group.
You keep the comparison
A document you can take to your partners, including what we did not recommend.
Bring your list
Your doctors, your prescriptions and the card you have now.
We check every plan
Each one available in your county, against that list rather than against a brochure.
You choose
We read out the trade-offs and enrol you in whichever one you pick.
Why this desk
Four reasons employers stay past year one
None of them are a discount.
Independent, and it is checkable
Appointments with every carrier on the panel and a captive contract with none of them.
No cost to the client
Employers pay nothing, individuals pay nothing, and the carrier schedule does not vary.
Education before enrollment
We would rather spend an hour talking you out of a plan than ten minutes selling it.
Numbers, not adjectives
Every recommendation arrives with the arithmetic behind it, and you keep the comparison.
They started our renewal in June for a November anniversary. By the time the incumbent's letter arrived we already knew what the rest of the market would do, and the conversation went very differently.
Free employer kit
Four tools we use on every group
Yours to keep, whether or not you ever call us.
- The 150-day renewal calendarWeek by week, from first data pull to enrollment meeting.
- Census templateThe six columns a carrier actually needs, ready to fill in.
- FTE counting worksheetPart-time hours to full-time equivalents, with the rounding rule.
- Contribution split modellerWhat 50, 75 and 100 percent do to your payroll deduction.
In their words
What people say after year one
4.9 out of 5 across 486 reviews.
They started our renewal in June for a November anniversary. By the time the incumbent's letter arrived we already knew what the rest of the market would do.
Alicia FerraroDublin, Ohio · Group benefits renewal I sent a spreadsheet on a Tuesday and had three real comparisons by Friday. No pitch, just the numbers and what each one would cost my people per pay period.
Ben OkonkwoGahanna, Ohio · Census quote, 41 lives We were at 54 percent participation and one carrier away from being unquotable. Changing the contribution split fixed it in one cycle.
Dwight AmbroseGrove City, Ohio · Participation redesign
Harold told me the cheaper plan would not cover my rheumatologist and steered me away from it. That is not what I expected from an insurance appointment.
Marta KowalczykWesterville, Ohio · Turning 65 review Renata caught that my income estimate was going to leave me owing money in April and fixed it in July. I had no idea you could update it mid-year.
Serena DuplessisHilliard, Ohio · Self-employed Marketplace They re-ran my prescriptions in October and found the same drug two tiers lower on another plan. That was a real saving, not a rounding error.
Odette NwankwoDublin, Ohio · Part D drug review
Affiliations
Where this desk answers to somebody
Membership bodies, standards boards and the designations they award.
- Arcwell InstituteMember firm
- Lanterncrest BoardRegistered practice
- Ohio Brokers GuildChapter member
- Great Lakes ExchangeParticipating desk
- Employer CouncilCorporate member
- Fair EnrollmentSignatory
- Certified Benefits & Group Advisor
- Registered Medicare Benefit Advisor
- Accredited Coverage & Enrollment Specialist
- Accredited Retirement Income Specialist
- Certified Benefits Compliance Professional
Guides
Guides we wrote because clients kept asking
What a group census actually does to your quoteSix columns decide the number on your renewal letter. Here is what each one moves, and why a clean census beats a fast one.Read the guide - Compliance · 8 min readCounting to fifty: how the employer mandate really counts your staffThirty hours, not forty. Part-timers that roll up. Three LLCs that are one employer. A plain-language walk through the ALE test.
Employers · 7 min readYour cheapest carrier may not reach your workforceHMO, EPO, POS and PPO behave very differently once your people live in more than one county. What a distributed team loses at the line.
Employers · 6 min readThe contribution split is a participation lever, not just a costMoving from 50 to 75 percent of the employee-only premium costs money and frequently pays for itself in the next renewal. Here is the mechanism.
Straight answers
Questions we get every week
If your question is not here, call the desk. Nobody will put you on a list for asking.
Nothing. 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 carriers on our panel. Your premium is the same whether you enroll through us or directly.
Independent. We hold appointments with every carrier on our panel and we are captive to none of them. That is the whole point of the model: we can walk you away from a plan without losing anything.
Eighteen across medical, dental, vision, life, disability and supplemental lines. The whole panel is on our carriers page.
A census: each employee's age, dependent tier, home ZIP and whether they are currently enrolled or waiving. Names are not required for a first look. Your current plan summary and renewal date make the comparison far more useful.
A first-pass comparison from a clean census is usually two to four business days. Level-funded and self-funded options need medical underwriting, which adds one to two weeks.
Most require 50% to 75% of eligible employees enrolled, after valid waivers are removed from the denominator. Employees covered by a spouse's plan, a parent's plan, Medicare, TRICARE or Medicaid usually come out of the count.
No agency does. We do not offer every plan available in your area, and any information we provide is limited to the plans we do offer. For information on all of your options, contact Medicare.gov or 1-800-MEDICARE.
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.
Credentials, explained
What the letters after a name actually mean
Five designations at this desk. Here is what each one covers.
Certified Benefits & Group Advisor
Group plan design, funding models and renewal negotiation for employers between two and five hundred lives.
Arcwell Institute of Benefits Practice
Registered Medicare Benefit Advisor
Medicare parts, enrollment windows, late penalties and the Advantage versus Supplement decision.
Arcwell Institute of Benefits Practice
Accredited Coverage & Enrollment Specialist
Marketplace subsidy mechanics, household income reporting and mid-year qualifying events.
Lanterncrest Standards Board
Accredited Retirement Income Specialist
Claiming-age break-even work, spousal and survivor strategy, and income sequencing.
Lanterncrest Standards Board
Certified Benefits Compliance Professional
Full-time equivalent counting, affordability safe harbours, minimum value and annual reporting.
Arcwell Institute of Benefits Practice