Small business health insurance in Wisconsin: The ultimate guide
Are you a small business owner in Wisconsin looking for the best health insurance options for your team? Whether you’re seeking to offer health benefits for the first time or looking to switch from your existing insurance company, this guide will help you navigate the complex world of small business health insurance in Wisconsin, including:
- Wisconsin employer health insurance laws
- Costs of Wisconsin health insurance for small businesses
- Modern small business health insurance companies in Wisconsin
- Legacy small business health insurance companies in Wisconsin
- Group medical insurance brokers in Wisconsin
Providing health insurance is a key factor in attracting and retaining top talent in today’s competitive job market. According to a 2022 Willis Towers Watson survey, 48% of employees stated that health and retirement benefits were a key reason to join a company, and 60% said those benefits were a key reason to stay with a company.
Offering health insurance comes with numerous other advantages, such as a positive work environment, improved employee morale, increased employee productivity, and improved overall efficiency.
Wisconsin state regulations for health insurance
According to Wisconsin law, small employers can choose whether or not they offer health insurance to their employees.
In Wisconsin, a small employer is defined as a business with 2 to 50 eligible employees. According to the Affordable Care Act (ACA)’s employer shared responsibility provision, larger businesses with 51 or more full-time employees are required to provide insurance to at least 95% of their eligible employees.
An eligible employee is anyone who regularly works 30 or more hours per week on a permanent basis. Eligible employees include employees covered under the health benefit plan, including:
- A sole proprietor
- A business owner
- A business partner
- A member of a limited liability company (LLC)
Contract workers, temporary workers, and those who work less than 30 hours a week are not full-time employees.
Small employers may also offer coverage to part-time employees who work less than 30 hours a week on a permanent basis. If they choose to do so, they must offer coverage to employees without discrimination.
Tax credits for small business health insurance in Wisconsin
Small employers that provide medical insurance in Wisconsin may qualify for a federal tax credit through a small business health options program (SHOP). The government may cover up to 50% of premium contributions for for-profit businesses, and up to 35% for tax-exempt non-profit businesses.
To qualify for the tax credit, they must meet several stipulations:
- Have less than 25 full-time employees making about $56,000 per year or less
- Pay at least 50% of their full-time employees’ premium costs
- Offer SHOP coverage to all full-time employees
The cost of health insurance in Wisconsin for employers
Wisconsin’s typical annual premiums for employer-sponsored health insurance are slightly lower than the U.S. average, which is $7,911 for individual coverage and $22,463 for family coverage. According to KFF’s state-specific premiums reports from 2021, Wisconsin’s average annual premiums were $7,254 for individual coverage and $21,166 for family coverage. Employers contributed about 72% of the premium for single insurance plans and 74% for family insurance plans.
Average annual premium for single coverage in Wisconsin
Average annual premium for family coverage in Wisconsin
Best health insurance for Wisconsin small businesses
Many health insurance companies cater specifically to small businesses, and they each have their own unique offerings, advantages, and features. Exploring each option will help you make an informed decision when selecting the best health insurance plan for your Wisconsin small business.
Modern insurance companies serving small businesses in Wisconsin
A variety of innovative modern insurance companies are emerging to challenge the small business health insurance market. They focus specifically on creating health plans tailored for small businesses.
Many modern insurance companies utilize level-funded health plans, which offer the most cost-effective solutions for small businesses. Level-funding means that small businesses only pay for the healthcare their employees use, plus some fixed administrative fees.
Small businesses save money they’d otherwise spend on high premiums for potentially unused benefits. In addition, stop-loss insurance safeguards the employer if employee health expenses ever exceed a certain threshold.
Modern insurance companies also focus on improving value-based care instead of traditional fee-for-service models. This patient-centric approach to care focuses on delivering high-quality, efficient, and cost-effective services to patients. At its core, it aims to improve patient outcomes while reducing overall healthcare costs by emphasizing:
- Preventive measures
- Effective management of chronic conditions
- Coordinated care among healthcare providers
Modern companies are pioneering the transition from a model that pays providers based on the volume of services rendered to a system that rewards providers for delivering quality care and achieving positive patient outcomes.
Sana is an excellent modern insurance option if you’re a small or medium business (SMB) owner in Wisconsin with 5 to 300 employees.
We address common problems for small businesses when it comes to health insurance through:
- Accurate pricing: The pricing of our self-funded plans is directly related to your expected cost of claims. If your group is expected to have low healthcare costs, you’ll see significantly lower premiums.
- Comprehensive coverage: Our comprehensive health plans include medical, dental, and vision coverage.
- Free best-in-class care: We work with over a dozen partners providing $0 best-in-class healthcare services, such as maternity, virtual care, imaging, labs, physical therapy, and more.
- A large, national PPO network: Your employees get access to over 1.7 million provider locations, plus the flexibility to see providers outside of the network — all without ever being charged out-of-network fees..
- Easy benefits administration: We make plan management easier than ever before through our intuitive admin toolkit. You can breeze through open enrollment, reconcile invoices, add and remove employees in real time, and easily view your claims spend — all in one easy-to-use dashboard.
And if you have any questions or problems, our fast, dependable support team is always available. You can get in touch with us via chat, phone, or email and get a response in minutes.
Legacy carriers of small business health insurance in Wisconsin
Legacy insurance carriers are well-established, large-scale insurance companies with a long history in the industry. They offer insurance for businesses of all sizes, making them a viable option for SMBs. The top three companies offering small business health insurance in Wisconsin are United Healthcare, Quartz Health, and Anthem.
United Healthcare offers level-funded plans and a dedicated team of licensed service advisors. They also have a broad provider network and additional resources like virtual care, online tools, and wellness programs.
Quartz Health provides a diverse array of Wisconsin health insurance plans and services, including health maintenance organization (HMO) and point of service (POS) plans. They partner with an extensive network of healthcare providers and offer resources such as online tools and wellness programs.
Anthem provides HMO, preferred provider organization (PPO), and health savings account (HSA)-compatible plans to suit various needs and budgets. Much like the other legacy companies, they have a vast network of healthcare providers. They also offer valuable resources like virtual care, wellness programs, and online tools.
Getting quotes for group medical insurance in Wisconsin
You can get quotes for group medical insurance in Wisconsin in several ways, including:
- Utilizing online quote comparison tools
- Visiting the SHOP Marketplace
- Consulting with a health insurance broker or agent
You can also get a quote with Sana today.
Group health insurance brokers in Wisconsin
Partnering with a group health insurance broker can be an effective way for small businesses in Wisconsin to navigate the complex world of group health insurance.
These licensed professionals have in-depth knowledge of the industry, local regulations, and the specific needs of small businesses. So they can help you find the most suitable and affordable health insurance in Wisconsin. The best brokers also serve as your advocate, helping you save money through value-based payment models and level-funded plans.
To find the best agent for your small business, you can use a Wisconsin broker finder such as:
- Mployer Advisor
- Wisconsin Health Agents
- The Society for Human Resource Management (SHRM)’s Broker Finder
Alternatively, you can go directly to our Sana plans page to learn more about Sana Benefits.
Wisconsin small business health insurance FAQs
Yes — Wisconsin has a federally facilitated SHOP marketplace as mandated by the Affordable Care Act (ACA). SMBs seeking small group health insurance benefits for eligible employees can visit SHOP to find and compare companies.
Wisconsin BadgerCare Plus is a comprehensive healthcare program for low-income pregnant people, adults, and children in Wisconsin. It is designed to provide eligible Wisconsin residents with access to affordable, quality healthcare services. It may also help them find a job, pay for food, or cover childcare costs.
On average, most employers in Wisconsin pay around 72% of health insurance for single coverage and 74% of health insurance for family coverage.