Employee Benefits
Group Health Insurance for Washington Employers
Group health insurance is the single largest line item in most benefits budgets and the one employees judge you on. It is also the one most employers only think about for three weeks a year, when the renewal arrives.
Washington employers up to 50 employees buy in the small group market. Above that, large group rules apply.
Paid Family and Medical Leave job protection begins at 15 employees, down from 25.
Up from 1.13%, split 29.3% employer and 70.7% employee.
We work with Washington employers on the whole cycle. Designing the plan, taking it to market, explaining the options in language your team can act on, and running it properly for the eleven months after open enrollment ends.
Who can offer group coverage
Group coverage is employer sponsored, which means the business buys it and offers it to eligible employees. In Washington the small group market covers employers up to 50 employees, with the large group market above that.
Carriers set their own rules on top of that: minimum enrollment, what share of eligible employees must participate, and how much the employer must contribute toward the employee premium. Those rules differ between carriers and they are a common reason a group gets declined by one and accepted by another. Working out which market will take your group is part of what a broker is for.
What a group medical plan includes
- Medical coverage for employees, with optional dependent coverage
- Preventive care and wellness benefits
- Prescription drug coverage
- Plan design options including HMO, PPO and high deductible plans paired with an HSA
- Dental and vision, either bundled or placed separately
- Voluntary coverages such as life, disability and critical illness, which employees pay for themselves
How your plan is funded, and why that matters more than the network
Most employers never get this explained, and it has more effect on your cost over time than which network you pick.
Fully insured
You pay a fixed premium and the carrier takes the risk. Predictable, simple, and you see nothing about how your own group actually used the plan. If your employees are healthier than the carrier assumed, the carrier keeps the difference.
Level funded
You pay a level monthly amount that covers expected claims, administration and stop loss protection. If your group’s claims come in under expectation, some of the surplus can come back to you. It behaves like a fully insured plan from a cash flow point of view but gives you claims data and a share of good experience.
Self funded
You pay claims as they occur, with stop loss insurance capping your exposure. Most control, most data, most volatility, and it generally suits larger or very stable groups.
The right answer depends on your size, your claims history and how much variability your cash flow can absorb. It is worth revisiting rather than defaulting to whatever you set up years ago.
What changes for Washington employers on January 1, 2027
Two state programs sit on top of your group plan, and one of them changes.
Paid Family and Medical Leave job protection reaches employers with 15 or more employees. The threshold was 25 in 2026 and 50 in 2025. An employer between 15 and 24 employees acquires the obligation without hiring anyone.
That matters to your benefits plan specifically, because an employer who owes job protection must maintain the employee’s health insurance as if they were still working.
The premium rate also goes to 1.2%, up from 1.13%, split 29.3% employer and 70.7% employee.
Current as of November 2026. The Employment Security Department has said its job protection rules may still be finalized, so confirm anything time sensitive before acting on it.
What your broker should actually be doing
At renewal
A renewal is a decision, not a letter to forward. You should get a recommendation: accept it, market it, or change the design, with the reasoning attached. If what arrives is the carrier’s number and nothing else, you are paying for a mailbox.
At open enrollment
This is the only time most employees think about their benefits. Materials they can understand, meetings if the group needs them, and someone who answers the phone during the window.
The rest of the year
Claims questions, eligibility changes, new hires, terminations, leave administration, and compliance questions answered the same day rather than the following week.
Meet Your Employee Benefits Advisor
Heather Mears
Employee Benefits Account Executive
Heather works with Washington employers on the design, placement and day-to-day management of their group benefit programs, with more than a decade in employee benefits. She spent six years as a senior account executive at Connexion Insurance Solutions, then at Parker, Smith & Feek, which later became part of IMA Financial Group, focused on group medical, dental and vision, renewal strategy, compliance support and open enrollment.
You work with Heather directly, eleven months a year as well as at renewal. Ask her to look at your renewal: send your current plan summary and your most recent renewal, and she will tell you what she would do differently and whether it is worth marketing.