Inputs
Example data table
| Item | Example |
|---|---|
| Employees | 12 |
| Participation | 85% |
| Average age | 38 |
| Location factor | 1.05 |
| Tier | Gold |
| Coverage | Employee + children |
| Network | PPO |
| Deductible | $2,500 |
| Employer contribution | 75% |
| Wellness discount | 5% |
| Dental add-on | Yes |
| Admin fee | $20 |
| Advisor fee (annual) | $1,500 |
How to use
- Set employees and participation to estimate enrolled count.
- Enter base rate aligned with your local quotes.
- Choose tier, coverage, network, and cost-sharing values.
- Set employer contribution, discounts, and optional cap.
- Add fees, add-ons, and employer account contributions.
- Press Calculate, then export CSV or PDF.
Formula used
medical = per_enrolled × enrolled
fees = (admin_fee × enrolled) + other + (advisor_annual ÷ 12)
employer_medical = medical × employer_pct (then capped if enabled)
next_year ≈ annual × (1 + renewal_increase%)
phaseout = max( clamp((FTE−10)/15), clamp((avg_wage−28000)/28000) )
effective_rate = credit_rate × (1 − phaseout)
annual_credit ≈ employer_medical_annual × effective_rate
Notes for practical planning
- Use participation to avoid overstating costs for optional enrollment.
- Try an employer cap if you want predictable premium budgeting.
- Add dental/vision and account contributions to reflect total benefits spend.
- Use renewal increase to compare current and next-year budgets.
Benchmark your base rate
Begin with a reference base rate that matches a real quote in your market. Use employee-only pricing near age 35, then adjust the location factor for regional cost pressure. The calculator scales the baseline by tier, network, and prescription richness to produce a per-enrolled medical premium for comparisons. If results seem high, recheck base rate, coverage type, and assumptions. Keep a short history of renewal letters and carrier changes to calibrate future scenarios.
Model enrollment and contribution strategy
Participation sets enrolled headcount and drives premiums, fees, and add-ons. Choose a contribution that supports retention while controlling payroll deductions. Enable the employer medical cap per enrolled employee for a predictable budget. When the cap binds, the employee share rises and appears in the employee monthly total and sensitivity chart. Use participation for compliance targets and to model how many dependents you expect in practice.
Stress-test plan design levers
Premium is influenced by more than tier. Increase the deductible or out-of-pocket maximum to explore lower premiums, then reduce coinsurance or copays to test richer benefits. Network type also matters: broad access often costs more, while narrower designs may trade price for provider choice. Use the factor table to track how age, cost sharing, and network settings combine into one medical premium estimate.
Include fees and ancillary benefits
Administrative costs add up for small groups. Enter admin fees per enrolled employee, add flat monthly tools, and spread annual advisor fees across months. Enable dental or vision add-ons for fuller spend, and choose whether add-ons are employer-paid or shared. Employer account contributions are employer-only cash outflow that increases employer totals. Even small fees can change take-home pay.
Plan for timing, renewals, and cash flow
Cash flow depends on timing and trend. Use waiting period days to approximate first-year proration. Apply a renewal increase to estimate next-year totals and compare them with payroll growth. The annual employer net line subtracts a simplified credit estimate when enabled; validate eligibility and documentation separately.
FAQs
Use the monthly premium from your most comparable quote: employee-only, mid-level tier, average age near 35. Then adjust location factor and network to align the estimate with your market and carrier.
Participation converts headcount into enrolled employees. Premiums, per-enrolled fees, and add-ons scale with enrolled count, so lower participation reduces totals while keeping per-enrolled costs comparable.
It limits the employer premium share per enrolled employee. If premiums rise above the cap, the employee medical portion increases, which helps you model a predictable employer budget.
Higher deductibles or higher copays often reduce premium but can increase out-of-pocket exposure. Use these fields to compare designs and discuss employee impact before selecting a richer or leaner structure.
Yes. Dental and vision add-ons are added per enrolled employee and can be employer-paid or shared. Account contributions are treated as employer-only monthly cash outflow in the totals.
No. The credit shown is a simplified educational estimate based on medical spend, FTE, and wages. Eligibility and rates depend on current rules and documentation, so confirm with a qualified tax advisor.