Plumbing Business Group Health Insurance: The 2025 Guide
Everything an owner needs to know about quoting, choosing, and managing a group plan.
Updated January 2025 · 9 min read
Who qualifies as a small group in 2025
In most states, a plumbing business with 1–50 full-time-equivalent (FTE) employees qualifies for small-group health insurance. A handful of states (California, Colorado, New York, Vermont) extend small-group rules up to 100 FTEs. FTE counts include the owner if the owner is on payroll.
Two part-time employees working 15 hours each typically count as one FTE. Seasonal workers under 120 days are excluded. Your payroll provider's report is the document a carrier will ask for during underwriting.
The four funding models you'll be quoted
Fully-insured: the carrier takes the claims risk. Premiums are predictable but renewals can jump 8–25% if your group's claims run high.
Level-funded: a hybrid where you pay a fixed monthly amount, but unused claims dollars can be refunded at year-end. Underwritten by health questions; usually 10–25% cheaper than fully-insured for healthy crews.
SHOP marketplace: a fully-insured plan sold through the federal or state small-business exchange. The only path to the Small Business Health Care Tax Credit (up to 50% of premiums for groups under 25 FTEs paying average wages under $61,400).
ICHRA (Individual Coverage HRA): you reimburse employees tax-free for individual marketplace plans they pick themselves. Best fit for owners who want predictable costs and crews spread across multiple ZIP codes.
What employers typically contribute
Most carriers require the employer to pay at least 50% of the employee-only premium and at least 75% of employees to enroll (waivers for spouses with other coverage don't count against you).
For a 6-person plumbing shop in 2025, expect roughly $480–$720/month per employee for a mid-tier PPO, with the employer share running $240–$430. Adding family tiers raises the per-employee cost but the employer contribution % is calculated on the employee-only premium.
Documents to have ready before you quote
Most recent quarterly wage report (DE 9C in California, equivalent in your state).
A current census: each employee's date of birth, ZIP code, gender, tobacco use, and tier (employee, employee+spouse, employee+children, family).
Articles of incorporation or an EIN letter from the IRS.
Two months of payroll runs if you've been in business under a year.
Open enrollment and effective dates
Small-group plans can start the 1st of any month — you are not locked into November/January like the individual marketplace. To start coverage on the 1st, complete underwriting and pay the binder premium by roughly the 15th of the prior month.
Renewals are 12 months from your effective date. A licensed broker should re-shop at least 60 days before renewal; in our book of business, switching carriers at renewal saves the average plumbing shop $4,800/year.
Ready for a real quote?
Two minutes. No SSN required. A licensed advisor follows up within one business day.
