Start with the same assumptions, then compare coverage—not just premiums. Ask for each plan’s Summary of Benefits and Coverage (SBC), confirm the quoted coverage period and enrollment assumptions, and record employer costs, employee contributions, provider access, and unresolved questions side by side.
This checklist is for a small employer reviewing two group health insurance proposals, whether you are offering coverage for the first time or comparing a renewal with another option. It is not a recommendation to switch plans. The goal is to see exactly what you are comparing before you make that decision.
1. Make sure the quotes describe the same situation
Before comparing prices, ask the person preparing the proposals:
- Are both quotes for the same requested effective date?
- Do they use the same employee and dependent enrollment assumptions?
- Are coverage tiers shown separately, such as employee-only and family coverage?
- Is the employer contribution the same in both illustrations?
- Which fees are included, and which would be billed separately?
- Is the price final, or does it depend on information or requirements still being reviewed?
- When does each quote expire, and what must happen before coverage can begin?
If an assumption differs, mark it rather than treating the two totals as equivalent. A proposal based on fewer enrolled dependents is not a like-for-like comparison with one based on the full team’s requested coverage.
Keep a separate column for your current plan if you already offer coverage. Record the renewal proposal as well as the current terms; do not assume they are identical.
2. Put the SBCs next to each other
The Summary of Benefits and Coverage is a short, plain-language overview designed to help people compare health plans. HealthCare.gov explains that you can request an SBC from an insurance company or group health plan.[1]
Ask for the SBC matching the exact plan name and coverage period on each quote. Pair it with the full plan documents and the quoted rates. Do not substitute a generic brochure for the proposed plan’s documents.
Use the following checklist as your comparison sheet. For each row, record the answer for Plan A, Plan B, and your current plan if applicable. Write “needs confirmation” whenever a proposal leaves the answer unclear.
| Compare this | What to record for each plan |
|---|---|
| Plan identity | Exact plan name, plan identifier, coverage period, and document date |
| Monthly cost to the business | Employer contribution by coverage tier, enrollment assumptions, and separate fees |
| Monthly cost to employees | Employee contribution by coverage tier; confirm the payroll deduction schedule separately |
| Deductible | Individual and family amounts; which services have different rules |
| Cost when care is used | Office visits, specialists, urgent care, emergency care, hospital care, and outpatient procedures |
| Out-of-pocket limit | Individual and family limits, network rules, and what does not count toward the limit |
| Provider access | Exact network name, locations served, and checks employees need to complete |
| Prescription coverage | Current drug list, cost tiers, pharmacy requirements, and coverage restrictions to verify |
| Exclusions and limitations | Services not covered and restrictions that need a closer reading |
| Enrollment and administration | Required steps, deadlines, responsible contacts, and unresolved conditions |
This comparison sheet is a decision aid, not a substitute for the plan documents. If a summary and another document appear inconsistent, ask the carrier or administrator for a written explanation before selecting the plan.
3. Separate the business budget from employee exposure
Answer two different questions: “What will the company contribute?” and “What might an employee have to pay?” Do not combine them into one attractive-looking price.
For the business, compare the proposed contribution by coverage tier and ask what happens to the budget if enrollment changes. Identify who will handle deductions, enrollment changes, billing questions, and renewals.
For employees, compare the contribution for coverage with the deductible, copays, coinsurance, and out-of-pocket limit shown in the plan documents. Ask which services are subject to the deductible and how individual and family amounts work under that specific plan.
The out-of-pocket limit is not a ceiling on every health-related expense. HealthCare.gov notes that monthly premiums, noncovered services, out-of-network care, and provider charges above the allowed amount are not included in that limit.[2]
That is why a lower payroll deduction, by itself, does not settle the comparison. Give employees a clear view of the coverage terms as well as their contribution.
4. Check access using the exact plan—not just the carrier name
Make provider access a separate review step. Request the current directory for the exact proposed network and instructions employees can use to check their providers. Ask how to confirm a specific practice location and hospital, not simply whether a provider “takes” the insurance company.
For a team working in different locations, ask how each proposal would handle routine care where those employees live and work. Get answers about referrals, out-of-network services, and any geographic restrictions from the plan’s documents or administrator.
Give employees a private way to review prescriptions as well. Ask for the current drug list and instructions for checking the medication, dosage, pharmacy, and any requirements that apply. Avoid collecting a team-wide medication list yourself just to compare proposals.
Do not ask employees to send diagnoses, medical histories, or prescription details through a general business inquiry form or ordinary email. If personal information becomes necessary, first confirm the appropriate recipient and secure process.
5. Use coverage examples to compare—not to predict a bill
SBCs include coverage examples to illustrate how a plan covers common medical situations.[1] Review the same example in both proposals and note what drives the difference: deductible, cost sharing, or a limitation that needs explanation.
Use those examples as a starting point for questions, not a forecast of what a particular employee will spend. Ask the advisor to walk through the plan’s terms without using identifiable employee medical information.
A useful follow-up is: “Which difference in this comparison should we explain most clearly to employees?” That keeps the conversation focused on how coverage works rather than on the quoted price alone.
6. Keep supplemental benefits in a separate comparison
If a proposal bundles group health insurance with supplemental employee benefits, ask for separate descriptions and costs. Identify which document describes the group health plan and which describes the additional program. Do not count an added benefit as though it answers an unanswered question about the medical plan.
Keep any CHAMP discussion on the supplemental-benefits side of the review, not as a substitute for comparing group health insurance. If payroll, tax, or legal questions arise, have the appropriate qualified professional review the proposed arrangement rather than relying on a sales illustration.
7. Close the unanswered questions before you choose
Before making a selection, request written answers to these questions:
- Which costs or terms are still conditional?
- What changes from our current coverage, if we have it?
- What should employees verify about their providers and prescriptions?
- What are the application, enrollment, and requested effective-date steps?
- Who will confirm that the new coverage is in effect?
- If we switch, how will the transition from the existing plan be coordinated?
- Who handles employee questions, billing issues, and later enrollment changes?
Do not treat a quote or a submitted application as confirmation that coverage has begun. Ask for confirmation before arranging the end of existing coverage.
There may not be a single proposal that wins every row. Your decision should make the tradeoffs visible: the company’s contribution, employees’ coverage and costs, access to care, and the work required to administer the plan.
Bring your comparison questions to Coverage Babe
If you are reviewing a first group plan or a renewal, start with your business location, approximate team size, current coverage, and intended start or renewal date. You do not need to send employee records to begin.
Explore small-business health insurance guidance or contact Coverage Babe to discuss the questions you want to resolve. For a separate supplemental-benefits conversation, visit Employee Benefits.
This checklist is general educational information, not a quote or a determination of eligibility. Coverage, availability, costs, and enrollment requirements must be confirmed for the specific plan and business. Review the actual plan documents before deciding.
Sources
[1] https://www.healthcare.gov/health-care-law-protections/summary-of-benefits-and-coverage
[2] https://www.healthcare.gov/glossary/out-of-pocket-maximum-limit