If you’re a small business owner with 2 to 50 full-time equivalent employees, you’ve likely gotten dozens of cold calls and emails from brokers pushing plans that claim to be the “best fit” for your team, without asking about your budget or your staff’s specific health needs. Many brokers earn higher commissions for selling certain plans, so it can be hard to tell if a recommendation is aligned with your priorities or their bottom line. This resource walks you through a neutral, sales-pitch-free comparison process so you can evaluate options on your own terms.
What to ask a broker or carrier
Before you dive into plan details, start every conversation with three ground-rule questions to set expectations and avoid unneeded sales pitches. First, ask the broker or carrier representative to disclose any commissions, performance bonuses, or other incentives they earn for selling specific plans. If they refuse to share this information, you can end the conversation, as this lack of transparency means their recommendations may not be unbiased. Second, share your pre-defined budget range for monthly employer contributions per employee, and ask them to only present plans that fall within that range, no exceptions. If they try to steer you to a plan outside your budget, remind them of your limit and ask if they have other options that fit. Third, ask them to avoid pitching optional add-on riders, like accidental death insurance or critical illness coverage, until after you’ve narrowed down your core health plan options. This keeps the conversation focused on the priority benefit your team needs, rather than upsells that increase your overall cost.
Question list
After you set ground rules, use this standardized question list for every broker or carrier you talk to, so you’re comparing apples to apples across all options. Don’t let a representative skip questions or give vague answers; if they say they need to follow up with more details, note that in your records and wait to get that information before moving the plan to your shortlist. Break the questions into four core categories to keep conversations organized:
- **Cost sharing**: What is the total monthly premium per enrolled employee, split between employer and employee share? What is the individual deductible, family deductible, and out-of-pocket maximum for in-network and out-of-network care? Are there any copays for primary care, specialist visits, urgent care, or prescription drugs before the deductible is met? Is there a separate deductible for prescription drugs, or do drug costs count toward the general medical deductible?
- **Network access**: Is this an HMO, PPO, EPO, or POS plan? Are all of the top 3 most common local health systems and pharmacies our team uses in-network? Do out-of-network benefits apply only to emergency care, or to pre-approved elective care too? Does the plan require referrals to see specialists, or can staff book specialist visits directly?
- **Administrative requirements**: How long does open enrollment take to set up for our team? What is the turnaround time for adding new hires or removing terminated staff? Is there a dedicated account manager for our group, or do we call a general support line? Is there a digital portal for employees to view their benefits, print ID cards, and submit claims? What is the waiting period for new hires to access benefits after their start date?
- **Supplementary benefits**: Are telehealth visits covered at 100% before deductible? Are mental health, dental, and vision benefits included as core benefits, or are they add-ons? Are wellness incentives, like gym membership reimbursements, included at no extra cost to the employer?
How to record answers
Use the following fillable plan comparison worksheet to log all answers side by side, so you don’t have to rely on a broker’s pre-built comparison sheet that may prioritize higher-commission plans. You can add rows for criteria specific to your team, like fertility benefits if multiple staff have mentioned that as a priority, or international coverage if you have staff who travel regularly for work. If a carrier can’t give you a clear answer for any row, mark it as a red flag and follow up in writing before proceeding.
| Comparison Criteria | Plan 1 Name/Carrier | Plan 2 Name/Carrier | Plan 3 Name/Carrier | Notes |
|---|---|---|---|---|
| Broker/carrier disclosed commission/incentive for this plan? (Y/N) | ||||
| Total monthly premium per full-time employee | ||||
| Required employer contribution percentage of premium | ||||
| In-network individual deductible | ||||
| In-network individual out-of-pocket maximum | ||||
| Primary care copay (pre-deductible) | ||||
| Generic prescription drug copay (pre-deductible) | ||||
| Plan type (HMO/PPO/EPO/POS) | ||||
| Top 3 local health systems our team uses in-network? (Y/N per system) | ||||
| Specialist referral required? (Y/N) | ||||
| Telehealth covered 100% pre-deductible? (Y/N) | ||||
| New hire enrollment turnaround time | ||||
| Waiting period for new hires to access benefits | ||||
| Included add-on benefits (dental/vision/mental health) | ||||
| Digital employee self-service portal available? (Y/N) |
As you fill out this worksheet, avoid scoring plans based on a broker’s description of benefits alone. Ask for a digital copy of the official Summary of Benefits and Coverage (SBC) for every plan you’re considering, and cross-check the answers you got during the call against the SBC to confirm accuracy. If you spot a discrepancy between what the representative told you and what’s in the SBC, the SBC is the legally binding document, so go with that information for your comparison. You can also share this worksheet with your leadership team or a trusted staff representative to get input on which criteria matter most to your team, like lower deductibles for staff with chronic health conditions, or broader network access for staff who live in rural areas.
What not to promise employees
When you’re communicating with your team about upcoming plan options, it’s natural to want to highlight the benefits of the plan you’re leaning toward, but overpromising can lead to frustration and distrust later if details change. Don’t promise that all care will be free or 100% covered, because deductibles and copays still apply for most plans. Don’t promise that a specific doctor or pharmacy will always be in-network, because carrier networks can change mid-plan year with little advance notice. Don’t promise that premiums will stay the same for multiple years, because group plan rates are typically adjusted annually based on group claims and industry trends. Don’t promise that all prescription drugs will be covered, because formularies can change, and some specialty drugs may require prior authorization or step therapy.
Instead of making specific guarantees, frame updates as preliminary, and let employees know you’ll share full, official plan documents as soon as you finalize your selection. You can also invite employees to submit questions about the plan options, and pass those questions along to your broker or carrier to get official, written answers to share with the team.
Bottom line
Comparing small-group health plans doesn’t require specialized industry knowledge, just a consistent set of questions and a neutral way to log answers. By setting ground rules upfront to avoid sales pitches, you can cut through the noise and focus on plans that fit both your budget and your team’s needs. Once you narrow down your top 2 options, you can share redacted versions of the SBCs with your team to get feedback before making a final decision, which helps employees feel involved in the process and reduces confusion once open enrollment starts.
This content is for educational purposes only and does not constitute insurance, tax, legal, or medical advice. Always verify all plan details, eligibility requirements, and coverage rules with official plan documents, your state’s small-business health exchange, or a licensed insurance professional before enrolling in a group health plan.
Important note: This page is educational and is not insurance, tax, legal, or medical advice. Confirm current rules in your plan documents or with a licensed professional.