Your current plan,
audited in one table.
Off-the-shelf group plans leave 14 measurable gaps for companies between 50–500 employees. Here's where your spend is going — and where it isn't.
| Coverage Feature | YOUR LIKELYTypical Group Plan | UNDERWRITECorefrom $480/mo/ee | UNDERWRITE · RECOMMENDEDStructuredfrom $540/mo/ee | UNDERWRITEEnterpriseCustom pricing |
|---|---|---|---|---|
| Network | ||||
In-network provider breadth | ||||
Out-of-network coverage | ||||
Specialist referral-free access | ||||
Mental health parity compliance | ||||
| Cost Control | ||||
Level-funded structure available | ||||
Stop-loss reinsurance | ||||
Pharmacy benefit optimization | ||||
Annual renewal rate cap | ||||
| Compliance | ||||
ACA employer mandate tracking | ||||
COBRA administration | ||||
Section 125 cafeteria plan | ||||
State mandate monitoring | ||||
| Administration | ||||
Dedicated benefits concierge | ||||
HRIS integration | ||||
Open enrollment support | ||||
Claims dispute resolution | ||||
| Click any row with ⓘ for context | Avg. 6 gaps found | Learn more | Start here | Contact us |
The Structured tier closes every gap identified above and costs less than the industry average for companies 50–300 employees.
Download the 2025 Benefits Audit KitEight obligations.
Most companies miss three.
Every item below carries a specific penalty structure. Expand any item for a plain-English explanation of what it requires and what it costs to miss.
Applicable Large Employers with 50+ FTEs must offer minimum essential coverage to 95% of full-time employees or face penalties.
As of January 1, 2026, the penalty for failing to offer qualifying coverage is $2,900 per full-time employee (minus the first 30). For companies that just crossed 50 employees, this is the first mandatory trigger — and most discover it at renewal, not onboarding.
ALEs must file Forms 1094-C and 1095-C with the IRS and distribute 1095-C to each full-time employee annually.
Failure to file or furnish accurate forms carries a penalty of $310 per return (2025 rate), up to $3.78M annually. Underwrite handles all 1094-C / 1095-C preparation, filing, and employee distribution as part of every plan tier.
Employers with 20+ employees must offer continuation coverage to qualified beneficiaries upon qualifying events, with strict notice timelines.
The general notice must be provided within 90 days of plan enrollment. Election notices must go out within 14 days of the plan administrator learning of a qualifying event. Missing a notice deadline exposes the employer to $110/day in excise tax per qualified beneficiary — a single missed termination can cost more than the premium saved.
Employers sponsoring self-funded or level-funded plans must have executed BAAs with all vendors handling protected health information.
Under a fully-insured plan, the insurer assumes HIPAA responsibility. Under a level-funded structure (which Underwrite recommends for cost savings), the employer becomes a covered entity and must maintain BAAs with the TPA, PBM, and any wellness vendor. Underwrite provides pre-executed BAA templates and annual compliance audits as standard.
Group health plans cannot impose more restrictive financial requirements or treatment limitations on mental health benefits than on medical/surgical benefits.
The Consolidated Appropriations Act of 2021 added a Non-Quantitative Treatment Limitation comparative analysis requirement. Plans must document and make available to regulators proof that their NQTL analysis demonstrates parity. Underwrite's Structured and Enterprise tiers include annual MHPAEA compliance documentation as standard.
Thirty-eight states have benefit mandates that exceed ACA minimums — from infertility coverage in Illinois to autism therapy in California.
Fully-insured plans are automatically subject to state mandates. Self-funded plans are generally exempt (ERISA preemption) but states are increasingly aggressive. Underwrite monitors 50-state mandate calendars and alerts clients to changes that affect their plan design within 30 days of any legislative change.
Employers sponsoring applicable self-insured health plans must pay the Patient-Centered Outcomes Research Institute fee annually.
The 2025 PCORI fee is $3.22 per covered life. It's reported and paid via IRS Form 720 by July 31 each year. While the per-head amount is small, the filing obligation catches many newly level-funded employers off-guard. Underwrite calculates, prepares, and reminds clients of this obligation as part of plan administration.
Employers filing 250+ W-2s must report the aggregate cost of employer-sponsored health coverage in Box 12, Code DD.
This is an informational reporting requirement — the reported amount is not taxable to the employee. However, errors in the reported value trigger IRS correspondence. Underwrite provides employers with the precise per-employee cost figure needed for Box 12 reporting, formatted for direct payroll system input.
The 2025 Benefits Audit Kit includes a compliance calendar, penalty calculator, and state mandate tracker — pre-formatted for CFO presentation.
The 2025 Benefits Audit Kit.
Everything your CFO needs to sign.
Seven sections. Board-ready formatting. Used by 400+ HR teams to present benefits renewal recommendations with confidence.
2025 Benefits Audit Kit
Mid-Market Health Coverage Review
Download the 2025 Benefits Audit Kit
No phone number. No meeting request. Just the kit — delivered instantly.
Already in renewal season?
Run a Full Savings Analysis