Small business health insurance in South Carolina

Offering health insurance keeps your business compliant. But it also shows your employees you care, which can help make you an employer of choice.

Let's go over why providing health benefits to your employees in South Carolina is essential.

Group health insurance plans in South Carolina

Many business owners rely on traditional group health insurance plans for coverage. In a group plan, the employer and employees share the cost of premiums, with the employer typically taking on a larger share of the expenses.

With a group plan, employers can also extend coverage to spouses and children, significantly enhancing the value of the benefits offered to their employees.

There are several types of group health insurance plans available in South Carolina, including:

• Preferred provider organization plans (PPOs): PPOs are the most prevalent health plan option. Members benefit from a network of healthcare professionals. They can also seek services outside this network at an extra cost.
• Health maintenance organization plans (HMOs): HMOs offer a wide range of healthcare services through pre-established provider networks. Members must pick a primary care physician (PCP) to oversee their healthcare needs. Their PCP also provides referrals to specialists when necessary.
• Exclusive provider organization plans (EPOs): EPOs have similar features to HMOs and PPOs. Members can use a designated network of providers and consult specialists directly without needing referrals. However, care from out-of-network providers isn't covered under an EPO.
• Point of service plans (POSs): POS plans offer affordable rates for in-network doctor visits and also cover out-of-network services. Similar to HMOs, members need referrals from their PCPs to consult specialists.

Large companies often get better rates on group health insurance since they spread the risk over a bigger pool of employees. They also benefit from sharing the cost of premiums.

According to KFF³, employers cover about 83% of the premiums for individual plans and around 72% for family plans. Additionally, to qualify for a group health plan, you need about 70% of your employees to participate.

If a traditional group health plan exceeds your budget, a high deductible health plan (HDHP) may be a suitable alternative. An HDHP can offer cost savings by reducing monthly premium costs for employers and employees alike.

One downside of HDHPs is their high deductibles. Employees have to pay for more out-of-pocket expenses before their insurance coverage kicks in, which can lead to higher costs for your team.

To offset the cost of offering an HDHP, you can pair it with a group coverage HRA (GCHRA). Also called an integrated HRA, a GCHRA enables you to provide tax-free reimbursements to your employees for their out-of-pocket expenses, such as deductibles.

Small businesses with fewer than 50 FTEs can secure small business health insurance through a broker or directly from a health insurance provider. Additionally, if your business employs fewer than 25 workers, each earning an average annual wage below $50,000, you may qualify for the Small Business Health Care Tax Credit.

The following companies offer small group health plans in South Carolina in 2025, according to HealthCare.gov’s rate review website⁴:

How to take advantage of individual health insurance with an HRA

Whether it's due to cost or employee count, there's a better health benefit for your small business. Instead of going with a traditional group health plan, you can offer a stand-alone HRA to your employees. With an HRA, you can provide affordable health coverage to your employees by reimbursing them for their individual health insurance premiums.

There are several HRA-eligible expenses you can reimburse, including:

• Monthly premiums for health, vision, and dental plans

• Dental and vision expenses

• Preventive care

• Emergency care

• Prescription drugs

• Over-the-counter medication

• Mental health services

Two of the most popular HRAs are:

• The individual coverage HRA (ICHRA): The ICHRA works for organizations of all sizes, but it's particularly helpful for ALEs since it can satisfy the employer mandate. With no annual limits on employer contributions, you can offer your workers as much as you want as an allowance. You can also vary allowances using 11 employee classes, employee age, and family status. To participate in the ICHRA, employees need their own individual health insurance plans.

• The qualified small employer HRA (QSEHRA): The QSEHRA is only for small employers with fewer than 50 FTEs. Unlike the ICHRA, the QSEHRA does have annual limits on employer contributions. While you can't vary allowances using employee classes, you can still offer different allowance amounts based on an employee's age and family size. Employees only need health plans that provide MEC to participate in the QSEHRA. This means they can participate if they're on a spouse's or parent's health plan.

An HRA is particularly advantageous in South Carolina, where individual coverage typically costs a few hundred dollars less than small group insurance in nearly every county.

The chart below shows how much cheaper individual plans are on average in the three largest counties by population in South Carolina, according to Ideon⁵:

Ancillary and supplemental plans

Health insurance is the most important employee benefit you can offer, but you shouldn't stop there. You should consider offering ancillary benefits to create a more well-rounded benefits package.

Some ancillary and supplemental health benefits you can offer include:

• Dental coverage: Adult dental coverage is rarely included in standard health insurance plans. If you offer dental insurance as a bonus, you can help your employees with their pricey dental expenses. If you don’t want to offer a dental plan, you can use an HRA to reimburse them for their dental bills and individual dental plan premiums.

• Vision insurance: Like dental care, vision care isn't included in most health insurance plans. By adding vision coverage or using an HRA, you can help your employees with their vision expenses and also reimburse vision plan premiums.

• Health savings account (HSA): An HSA is an employee-owned account, but both you and your employee can contribute pre-tax funds to it. Your employees can access their HSAs whenever they need to pay for upcoming medical expenses.

• Flexible spending account (FSA): A healthcare FSA works like an HSA. It helps your employees cover out-of-pocket costs when they need medical care. It includes most of the same expenses that an HRA does, but it doesn't include reimbursement for health insurance premiums.

• Critical illness insurance: Critical illness insurance provides coverage for severe health conditions such as cancer, stroke, and kidney failure. It offers employees a lump sum of money to handle medical costs or lost wages during an employee's recovery.

Factors that impact the cost of health insurance in South Carolina include:

• The employee’s, spouse’s, or dependent’s age

• ZIP code

• The metal level or value of the plan (for small group and individual plans)

• The group’s medical claims history (for large group plans)

According to KFF's 2024 Employer Health Benefits Survey⁶, the average annual premium in the U.S. is:

• $8,951 for individual coverage

• $25,572 for family coverage

The table below presents the average lowest-cost premiums for each metal tier plan available on the federal exchange in 2025, according to KFF⁷.

South Carolina residents use the federal health insurance marketplace, HealthCare.gov. For 2025, there are six insurance providers offering plans, though the availability of these plans varies by rating area throughout the state.

The Open Enrollment Period in South Carolina is from November 1 to January 15 each year. Individuals with marketplace plans might qualify for premium tax credits provided by the federal government, commonly known as premium subsidies or health insurance subsidies.

During the 2024 Open Enrollment⁸, more than 533,000 people in South Carolina received premium tax credits for marketplace health plans. The IRS and the Marketplace originally used federal poverty guidelines to determine eligibility.

The Inflation Reduction Act eliminated the upper-income limit until the end of 2025. Anyone whose premiums exceed 8.5% of their household income can access these federal tax credits. With an extension of these credits seeming unlikely, eligibility may revert to only those with incomes between 100 and 400% of the FPL for 2026.

If someone misses the Open Enrollment Period, they can only enroll in a health plan by experiencing a qualifying life event that triggers a special enrollment period (SEP). Otherwise, they need to wait until the next Open Enrollment Period to sign up.

The table below shows the health insurance carriers that are offering plans on the individual market in 2025, according to HealthCare.gov’s rate review website⁴:

If you want to offer personalized health benefits to your employees, PeopleKeep by Remodel Health is here to help! Our HRA administration software streamlines to save you valuable time and resources.

Here's how offering an HRA through PeopleKeep by Remodel Health works:

• You offer either the ICHRA, QSEHRA, or GCHRA to your employees.

• You set a monthly allowance amount for your employees to use on medical expenses.

• With an ICHRA or QSEHRA, your employees purchase health coverage and other essentials using their own money.

• Your employees submit their eligible expenses for reimbursement through their PeopleKeep account.

• We approve their expenses, and you reimburse them up to their allowance amounts.

We also take care of these time-consuming tasks for you:

• Our team reviews reimbursement requests from your employees. We ensure they follow ACA, ERISA, and IRS regulations. This also keeps protected health information (PHI) safe to prevent your organization from any HIPAA violations.

• We generate legal plan documents and summary plan descriptions on your behalf.

• Our award-winning customer support team is available to help answer any questions you may have.

In addition to handling administration services, we support your employees as they shop for health insurance plans. After enrolling in their ICHRA or QSEHRA, your employees can easily explore their health coverage options directly from their PeopleKeep dashboard.

If you work with a broker, that doesn't have to change. Your broker can sell individual health insurance policies to your employees and assist you in managing your benefits. Have your broker reach out to us to learn more about setting up an HRA for your team.

For organizations with 50 or more employees that want additional compliance tools and hands-on support, Remodel Health’s ICHRA+ administration solution delivers a white-glove experience.