Small business health insurance in Indiana

Fully-insured traditional group health insurance

Many employers still choose traditional group plans due to their familiarity and ability to share health insurance premiums with employees. Business owners can also extend coverage to their employees’ spouses and dependents.

Common types of group health insurance plans include:

1. Preferred provider organization plans (PPOs) offer a broad provider network with some coverage for out-of-network care at a higher cost.
2. Health maintenance organization plans (HMOs) require employees to stay within a network and get referrals for specialists. But they generally have lower premiums.
3. Exclusive provider organization plans (EPOs) are a hybrid of PPO and HMO plans. They offer network-only coverage, but employees don’t need a referral to see a specialist.
4. Point of service plans (POSs) require referrals like an HMO. In-network costs are lower for members. But, the plan offers some out-of-network coverage at a higher price.

While larger companies may benefit more from group plans due to lower rates and have an easier time meeting the 70% participation requirement, smaller employers often struggle with high costs.

In 2024, the average single coverage premium was $8,951 annually ($746 per month), while family coverage averaged $25,572 annually ($2,131 per month)³. Employers typically cover a significant portion of these costs, adding to the financial burden.

Indiana small employers seeking group health insurance can shop for a plan on the federal Small Business Health Options Program (SHOP) Marketplace. Small group plans are only for businesses with fewer than 50 FTEs.

Do you have fewer than 25 FTEs and pay an average annual salary of $56,000 or less per employee? If so, you may qualify for the small business health care tax credit. To qualify, you must offer SHOP marketplace coverage and pay at least 50% of your employees’ premiums. Use the Marketplace’s Small Business Tax Credit Calculator to determine your eligibility for the federal tax credits.

According to HealthCare.gov's rate review site, the following health insurance companies offer small group plans in Indiana in 2025⁴.

Integrated HRAs

Small employers that want to offer group health insurance can supplement their policy with an integrated HRA. Also known as a group coverage HRA (GCHRA), this benefit is for employers of any size that offer group plans. Only employees enrolled in your group health plan can participate in the HRA.

With a GCHRA, you give your employees a monthly allowance that they can use for qualified medical costs. Once they prove they bought an eligible expense, you reimburse them tax-free up to their allowance amount. However, premiums aren’t eligible for reimbursement.

Eligible expenses include costs the group plan doesn’t cover or fully cover, such as:

• Deductibles: This is the amount employees must pay out-of-pocket before their insurance carrier starts covering their medical care expenses.
• Coinsurance: This is the percentage of costs employees must pay for a covered service after meeting their annual deductible.
• Copays: This is a set dollar amount employees must pay for covered healthcare services and items after receiving care.

A GCHRA can meet any organization’s needs and budget. GCHRAs can work with any type of group plan. But they especially pair well with high deductible plans, helping you manage higher deductibles while employers save on premiums.

Unlike other HRAs, GCHRAs don’t have minimum or maximum allowance limits, giving businesses more financial flexibility. Plus, employers can vary allowances and eligibility by seven employee classes for greater customization.

Stand-alone HRAs

When comparing individual and group health plans in Indiana, you can see that individual health insurance coverage is more affordable than employer-sponsored policies.

Below are the monthly premiums for a 50-year-old with a silver plan in some of the most populated Indiana counties in 2025:

All table data from Ideon’s 2025 premium comparison map⁵.

Stand-alone HRAs allow employees to buy individual health insurance while the employer reimburses their premiums and qualified medical expenses. These plans offer high flexibility and cost control without requiring employers to purchase group insurance.

There are two types of stand-alone HRAs:

1. The individual coverage HRA (ICHRA) is for businesses of all sizes. There are no minimum or maximum contribution limits, so it works for your budget. You can vary allowances and eligibility with employee classes or by family status, such as single. Your staff must have a qualifying form of individual health insurance coverage to participate.
   1. Instead of opting for costly group coverage, ICHRAs can help applicable large employers (ALEs) meet the ACA’s employer mandate requirements.
2. The qualified small employer HRA (QSEHRA) is for small employers with fewer than 50 FTEs. It has no minimum contribution limits, but the IRS sets annual maximum limits. Employees must have a healthcare plan with MEC to use the benefit.

Since individual premiums are typically more affordable than small group rates across Indiana counties, HRAs provide a scalable solution for budget-conscious organizations.

Association health plans

Small businesses and self-employed professionals can use association health plans (AHPs) to take advantage of group purchasing power and potentially lower insurance costs. AHPs bring together businesses from the same trade or geographic area, allowing them to buy coverage as a collective—often at more competitive rates.

These plans function much like traditional health insurance. But, they aren't required to follow every regulation under the ACA, and aren't available to ALEs. It's also important to note that AHPs may offer fewer coverage choices, which might not align with all of your employees’ healthcare needs.

If your organization needs more flexible or affordable options, an HRA is a more suitable alternative.

Supplemental and ancillary health insurance benefits

Even the most comprehensive health plans leave some gaps. That’s where supplemental and ancillary benefits come in—they provide added financial protection and help round out your overall benefits offering. While many of these options don’t meet MEC, you can pair them with major medical insurance or HRAs to build a more complete and supportive benefits package for your team.

Here are some popular types of supplemental and ancillary benefits:

• Critical illness insurance offers a financial cushion when employees are diagnosed with serious conditions such as cancer or heart disease.
• Accident insurance helps cover out-of-pocket costs from unexpected injuries.
• Dental and vision insurance are separate plans that cover essential services typically excluded from standard health coverage. You can also reimburse a wide range of dental and vision expenses with an HRA.
• Hospital indemnity insurance provides a payout to help manage expenses related to hospital stays not fully covered by traditional insurance.
• Health savings accounts (HSAs) are tax-free tools for employees with HSA-qualified health plans. Both employers and employees can contribute, and your staff can spend funds on current or future medical expenses.
• Flexible spending accounts (FSAs) let employees set aside pre-tax dollars to pay for eligible healthcare costs. However, employees can use FSA funds to pay for insurance premiums.

These additional benefits can give your employees more peace of mind and help position your business as an attractive, competitive workplace.