We all know that things change. However, while we might believe that “nothing is certain but death and taxes” as the proverb goes, even taxes change from year to year.

And this is equally true when it comes to the details, benefits, and requirements of small group health insurance.

Each year things change, costs typically go up, some aspects or features are added, while others go away. Unfortunately for the often overworked and excessively busy small business owner, small group health coverage isn’t really a “get it and forget it” product.

As we move into the year 2023 and are in the throes of open enrollment, the annual period when people can enroll in a health insurance plan for the next calendar year, changes may need to be made.

Keep in mind that qualified small business owners can obtain small business health policies any time during the year, unlike individual health plans. In other words, there is no standardized “open enrollment” period for small business health insurance.

However, once a year, usually during open enrollment, your plan’s premiums or benefits may come up for renewal. If and when this happens, it’s always a good idea to compare prices.



While there are certainly some aspects of healthcare that are somewhat subjective, such as quality of care and customer service, most factors regarding healthcare providers and plans are measurable. 

Each year, various entities take it upon themselves to rank or rate health insurance providers to help consumers determine the “best” in terms of various categories. These are typically ranked according to best value, best overall, highest quality, etc. 

Here is a brief overview of the best health insurance companies for 2023 based on the collective results of various sources.

  • Best Overall: Blue Cross Blue Shield
  • Best Value Plans: Oscar
  • Highest Quality Plans: Kaiser Permanente
  • Best Low-Cost Plans: Kaiser Permanente
  • Best Customer Service: Humana
  • Best for Transparency: UnitedHealthcare

Another source listed what they determined to be the top small business health insurance providers across the board:

  1. UnitedHealthcare
  2. Blue Cross Blue Shield
  3. Anthem
  4. Humana
  5. Kaiser Permanente
  6. Aetna

One more resource, the national Chamber of Commerce offered this ranking of what they considered to be the five best small business health insurance in 2022:

  1. Best small business health insurance: Aetna
  2. Humana: Quality health insurance for local businesses
  3. Kaiser Permanente plans for small businesses
  4. UnitedHealthcare plans for small businesses
  5. BlueCross BlueShield plans for small businesses

Of course, the “best” of anything when it comes to health coverage is largely dependent on the needs and preferences of those utilizing the services offered. 

For example, as Investopedia reports

“Ultimately, your options are limited by the availability of plans in your state and the drugs and services you need covered. But if you’re looking for well-administered plans and a positive member experience, Blue Cross Blue Shield offers a good value alongside strong ratings.”



It is quite possible that, after reviewing the plans and providers available for small group health coverage, you may want to consider alternative options to protect your employees at little or no expense to your company.

The most common option alternative for owners is to direct employees to their state’s individual health insurance exchange market, such as Covered California, for example. If you choose to do so, you can also reimburse some or all of the costs incurred by your employees.

According to HealthCoverageGuide.org,

“If an employee pays the premiums on personally owned health insurance or incurs medical costs and is reimbursed by the employer, the reimbursement generally is excluded from the employee’s gross income and not taxed under both federal and state tax law. This includes premiums for tax dependents and opposite-sex spouses. However, there are some circumstances in which the reimbursement is taxable income, including the following:

  • If an employer simply pays the employee an extra amount and does not specify in writing that the amount must be used to pay the health coverage premium, it will be taxable to the employee as income.
  • If the employer is self-employed, any reimbursements for their own or their dependents’ health care costs are taxable income to the self-employed employer.”

As a business owner considering this option, you will want to talk with your CPA or a tax professional beforehand.

Another option is to offer your workers what is known as a Qualified Small Employer Health Reimbursement Arrangement (QSEHRA). This is an arrangement that allows many small employers to contribute to their employee’s health care costs.

HealthCare.gov explains it this way,

“A QSEHRA allows small employers to provide non-taxed reimbursement of certain health care expenses, like health insurance premiums and coinsurance, to employees who maintain minimum essential coverage, including an individual Marketplace plan. In many states, QSEHRAs allow small employers to provide their employees additional plan choices without managing group health plan coverage.”

For a small business to qualify for a QSEHRA, an employer generally must:

  • Have fewer than 50 full-time employees
  • Provide the arrangement on the same terms to all full-time employees (reimbursement amounts may only vary based on age and the number of individuals covered)
  • Not offer a group health plan, like SHOP coverage or a flexible spending account (FSA)

In terms of typical costs with a QSEHRA, an employer can decide what amount to contribute to their employees’ health care costs, with an annual maximum that is set by the IRS.

For example, in 2022 the maximum employee-only contribution is $5,450 ($454.17 monthly), while the maximum for employees and households is $11,050 ($920.83 monthly).


J.C. Lewis Insurance is well-established and family-owned firm of expert brokers that has been in business here in Sonoma County for more than four decades. We offer small group health insurance plans from many of the leading health insurance carriers licensed to offer insurance in California.

In addition, we are fully licensed and certified by each of these insurance carriers to offer coverage to small group employers. J.C. Lewis Insurance Services provides services for Medicare supplemental and prescription drug plans for seniors.

If you’re a small business owner considering health insurance and even vision and dental insurance for your employees – or just for you and your family – you will likely have many questions and concerns.

At J.C. Lewis, we understand the needs and challenges of small businesses, and we know that providing California health insurance options for your employees can be a daunting and complex undertaking. Ideally, you will want to find a balance between keeping costs affordable for you, while offering the best options available to your workers.


J.C. Lewis Insurance Services welcomes your questions regarding insurance coverage, and you can be confident that we will help you find the right solution.