Group health your clients can afford, built so every employee is treated the same, and you keep the client.
October 2026 · info@benehive.tech · groups.benehive.tech
The problem
Costs are climbing faster than small employers can absorb
8–10%
Projected rise in employer health costs for 2027, the highest in 15 to 20 years
$1,000+
A month for one GLP-1 weight-loss drug, before rebates
+10.8%
Specialty drug cost trend in one year, driven by more people using them
+29%
Rise in million-dollar medical claims in a single year
Sources: Mercer, Aon, WTW and PwC 2027 cost projections · Mercer on GLP-1s · PSG 2026 drug trend report · Sun Life via Risk & Insurance
The problem
Why small groups get hit hardest
In a 40-person level-funded plan or PEO pool, the group is priced on its own claims. One sick person, or a few specialty prescriptions, can move everyone's rate.
One large claim or a few specialty drugs
Next year's rate jumps for everyone
Healthy employees drop out
The rate jumps again
The death spiral. A 500-person pool absorbs it. A 40-person pool can't.
Sources: Texas House bill analysis, HB 2146 · NAIC on small-group credibility and stop-loss
First, what a PEO is
A PEO becomes your client's co-employer
It runs the back office Payroll, payroll taxes, workers' comp and HR, usually for a fee based on payroll.
It puts everyone on its own health plan Your client's people join the PEO's master plan, pooled with its other small clients, for big-company rates.
Your client still runs the business Hiring, firing and the day-to-day stay with the owner.
230,000+
businesses use a PEO, about 15% of employers with 10 to 499 employees.
Florida has more PEO clients than any other state: 18%.
The pitch is big-company benefits. The catch is who owns the plan, the pool and the data.
Sources: NAPEO, PEO client research, Oct. 2025 · IRS, Certified Professional Employer Organization program
The villain
The PEO: a black hole
Carved off the plan
Groups that don't fit get a “soft transfer… for an open market quote.”
A PEO's own master-plan underwriting guide
Your data isn't yours
“Request all your data. Now… before you give notice.”
Advice to employers leaving a PEO
Locked in
60–90 days' notice, auto-renewals, lost deductible progress, and a two-year wait to come back.
Exit checklists and a PEO's own guidelines
The renewal black hole
“You asked for your claims data… and couldn't get it.” “Your last renewal arrived as a number.”
Warning signs employers are told to watch for
The villain
And the broker loses the client
“National and regional PEOs selling directly to a client could mean a loss for a broker's book.”
A PEO, writing to brokers
17%
of one national PEO's clients left in 2025, with price and service among the reasons
Clients don't stay in a PEO because it works. They stay because leaving hurts.
Sources: ExtensisHR on PEOs and brokers · Insperity 2025 Form 10-K
The workarounds
How the market carves employees up today
Classes
Hourly versus salaried, one location versus another. A different plan and a different price for each.
Splitting the company
Several companies so employees land on different plans. Risky: related companies are counted together for the 50-employee mandate.
PEO carve-offs
Small or sick groups priced off the master plan, on their own.
Every one of these treats employees differently. We don't.
The employer mandate applies at 50 full-time employees, counting full-time equivalents; companies under common ownership are counted together.
First, what level-funded is
One fixed payment a month, three parts inside
The employer pays the same amount every month
A claims fund
Pays the employees' medical claims.
Stop-loss insurance
Pays above a set amount, for one person or for the whole group.
Administration
The administrator that pays claims, and the network.
A good year Claims come in low. Some plans give part of it back.
A bad year Stop-loss pays the big claims, and next year's price goes up.
It's priced on the group's own health. 37% of covered workers at firms with 10 to 199 employees are on one.
Source: KFF, 2025 Employer Health Benefits Survey
The workarounds
Level-funded: the right tool for the right people
Healthy employees
Good fit. Priced on a healthy group's claims, it can cost less than a regular fully insured plan.
Sick employees on the same plan
Bad fit. Claims hit the stop-loss, one person's or the whole group's. Next year's renewal jumps, and it's the same song and dance again.
We don't avoid level-funded. We protect it, by keeping it for the people it's built for.
Our answer
We treat the plans differently. Every employee is treated the same.
Same price for their tier. Same out-of-pocket maximum. Same service.
The math
Healthy or sick: a $0 deductible and one price
One employee has a serious condition; everyone else is healthy. Single coverage, real monthly prices.
Diamond
$873 /mo
For healthy employees. Cigna PPO network.
Deductible
$0
Out-of-pocket max
$6,000
Doctor / specialist copay
$25 / $50
Guarantee-issue plan
$1,788 /mo
Takes anyone, any condition. Cigna PPO outside New York.
Deductible
$0
Out-of-pocket max
$7,350 (HRA covers above $6,000)
Doctor / specialist copay
$30 / $60 (HRA pays back $5 / $10)
A 40-person group
39 on Diamond at $873 = $34,047 1 on the guarantee-issue plan = $1,788
$35,835 a month, split 40 ways
$896 each
At 80/20, each employee pays $179
The sick person's plan adds about $23 a month to the price: about $4.60 from each paycheck at 80/20. They send in their EOBs, and the HRA pays back the extra $5 or $10 on each copay and anything above $6,000. Same deductible, same copays, same max, same price for everyone.
Example: single coverage, real monthly prices. Each tier (member, spouse, child, family) gets its own one price from the census.
Our answer
One group, several pools, one price
Your client's census
One health questionnaire
Any plans work, including ones you bring. Everyone is on a major network.
Level-funded plans: Cigna, Aetna, United and more for healthy employees, by state and industry
Backed by stop-loss and reinsurance Nationwide, Gerber Life, OdysseyRe and others
Guarantee-issue plans for employees with conditions
One price per tier
and one out-of-pocket max for every employee
GLP-1s and wellness care go through Curate Health, outside the plan, so the pools don't carry them.
Sources: Nationwide, medical stop loss (nationwide.com/business/employee-benefits/group/medical-stop-loss) · Gerber Life, medical stop-loss (Western & Southern SEC filings) · OdysseyRe, Accident & Health reinsurance (odysseyre.com/products/accident-health)
The GLP-1 problem
Expensive drugs used to be rare. Common drugs used to be cheap. GLP-1s are both.
Specialty drugs
Very expensive, but only a few people need them.
Everyday drugs
Blood pressure, cholesterol. Millions take them, and they cost a few dollars.
GLP-1s
They work, they cost over $1,000 a month, and a huge share of adults want one.
1 in 8
adults are taking a GLP-1 right now
91% → 63%
of Ozempic users on employer plans had a diabetes diagnosis, 2019 to 2022. The diabetes drug is going to people without diabetes.
$1,350
a month, Wegovy's 2026 list price. About $675 from January 2027, still over $8,000 a year.
Sources: KFF Health Tracking Poll, Nov. 2025 · Health Care Cost Institute, Apr. 2025 · Axios, Feb. 24, 2026 (Novo Nordisk price cut)
The GLP-1 problem
Every GLP-1 claim comes back as next year's rate
A 50-person group
If 1 in 8 is on a GLP-1, that's about 6 people.
$48,600 to $97,200
a year in drug claims, at $675 to $1,350 a month each.
Those claims go into the pool, and the pool sets the renewal. Next year, everyone pays for them.
$500K → $1.2M
One employer's GLP-1 budget, and what it spent the next year
13%
of Bank of America's total health spending goes to GLP-1s: $250 million a year
36%
of employers cover GLP-1s for weight loss. Most say no, and their people go without.
The 50-person group is an example. Sources: Peterson-KFF Health System Tracker, Oct. 2025 · Marketplace, Aug. 24, 2026 (IFEBP 2026 survey) · KFF poll, Nov. 2025
Our answer
GLP-1s go through Curate, not the health plan
Everyone on the plan is a member
Every employee who takes the health plan is in Curate automatically. Nobody needs a diabetes diagnosis to get help.
One flat membership
A provider visit every month, and GLP-1 medication included when the provider prescribes it. It's part of the group's all-in price.
The plan never sees the claim
GLP-1s for weight loss stay off the health plan, so they never land in the pool or the renewal.
Employees get the drug that works. The employer gets a flat, known cost instead of $8,000 to $16,000 a year per person at risk.
Our answer
One price, one protection
One price per tier
Member, member + spouse, member + child, family. One price each, company-wide.
One paycheck deduction
At $1,000 a month with the employer paying 80%, everyone pays $200 on any plan.
One out-of-pocket max
Everyone's max is $6,000. If a plan's max is higher, the company covers the difference.
How the company covers the difference, and only when someone actually reaches it
An HRA covers the gap, tax-free Employer money, with no IRS dollar cap. Money nobody uses never leaves the employer.
Even a wide gap pays for itself Two employees hit a $5,000 gap: $10,000, against $200,000 saved on premiums.
The employer manages one percentage. Employees see one price.
Dollar figures are an example. Each group is priced on its own census. Source: IRS Publication 969, Health Reimbursement Arrangements (irs.gov/publications/p969).
Our answer
Never locked in: the right plan, every month
With a PEO, a group is stuck on one plan until renewal.
With us, every employee is on the plan that fits them, every month. Moving isn't leaving us or leaving the group.
When someone gets sick
They need an expensive drug their plan won't cover, or would push into managed care.
We move them to the guarantee-issue plan already set up for the group. Same price, same group, no waiting for renewal.
Our answer
Real people, with skin in the game
Every group, every month
Our team reviews each group's placements. People make these calls, not software.
We keep the healthy pools healthy
When we place a group, we're vouching to the carrier that its healthy pool is healthy. Many of our groups share the same plans, so if we let it slip, the rate goes up for them too, not just your client. Our carrier relationships ride on getting it right.
Our answer
We catch what nobody else catches
Everyone is on the portal, so we see the life events that usually fall through the cracks and reach out before there's a gap.
A child aging off the plan, at 26 or later where state law extends it
A spouse turning 65: we handle the move to Medicare
A move to a new state or area
A birth or a marriage, updated on time
The employer doesn't have to know the rules. We do.
What everyone gets
Every group gets its own benefits portal
Branded for the employer, with your agency's name, website and email on it. Every email goes out under your name.
Employees
Their plan, tier and ID card
What comes out of their paycheck
GLP-1 and wellness care through Curate Health
Add-ons: gym, executive packages, air evacuation
The employer
Upload documents
Add or remove employees
See every request and where it stands
One place for the whole company's benefits
What everyone gets
Everyone wins, including you
The employer
Fair to every employee
One percentage to manage
Unused out-of-pocket money stays theirs
A recruiting and retention tool
Employees
Same price for their tier
Same out-of-pocket protection
Their own portal and login
GLP-1 and wellness care through Curate
You, the broker
Your name on the portal and emails
The client stays with you, not a PEO
We do the questionnaires, placement and service
More to sell: Curate and add-ons
How it works
How a group comes on
1
Health questionnaire
Fills in from the census. Dependents and Social Security numbers are collected once, never again.
2
Placement and pricing
We place every employee and review it all with the employer: plans, technology, Curate and the savings.
3
Elections
Employees pick coverage at the one price and see exactly what comes out of their paycheck.
4
The portal
Benefits, cards, Curate, add-ons, and ongoing service, every month.
What employees see · 1 of 6
The invitation
Every employee gets their own email from your agency, on their employer's letterhead. One button to choose a password, and from then on it's their benefits page.
Email to Sam Okafor
Real screens, under a made-up agency (Lindenhall Benefits) and a made-up employer (Harbor Point Logistics).
What employees see · 2 of 6
Step one: who's covered, and a few health questions
Answered once, and it saves as they go. Their health answers never go to the employer.
Real screens, under a made-up agency (Lindenhall Benefits) and a made-up employer (Harbor Point Logistics).
What employees see · 3 of 6
Choosing the plan
Each plan laid out the way you'd show it: the network, the deductible, the out-of-pocket max, the copays, and exactly what they pay. Diamond for a family is $1,687 a month; with the employer paying 80%, they pay $337.40.
Preview of a screen being built. Prices from the 40-person example; the company and the people are made up.
What the employer sees · 3 of 8
Every dollar, itemized
One account, every service on its own line, drawn on the 1st. They see it all and switch services on or off. Payroll, HR help and workers' comp are coming soon.
Preview of a screen being built. The technology fee is an example.
The problem nobody sees coming
Low pay and lots of waivers: that’s how the IRS fine finds a company
50+
Full-time workers, counting part-timers’ hours together. At 50, the company has to offer coverage its full-timers can afford.
1 person
One full-timer who waives, buys on the exchange and gets a subsidy is all it takes to set off the fine.
$5,010
A year for each full-timer who gets a subsidy, when the company’s offer wasn’t affordable.
$3,340
A year for every full-timer, minus the first 30, when coverage wasn’t offered to 95% of them.
A restaurant with 80 full-timers.Cooks and servers earning $16 an hour can’t spare $175 a month, so most of them waive. Earning that little, they qualify for a big subsidy on the exchange. If 27 of them take one, that’s 27 × $5,010 = $135,270 for one year. The bill comes two years later, as a Letter 226‑J, and the company has 90 days to prove what it offered and who signed a waiver.
IRS, Internal Revenue Code Section 4980H, amounts for 2026. The restaurant is an example.
Who needs this most
Built for companies with 50 or more full-timers
Under 50 full-timers
The IRS employer fine doesn’t apply, and there’s no 1094-C to file. They still get the plans, the portal and the HRA.
50 or more full-timers
The fine applies. Every full-timer needs a 1095-C every year, a 226‑J can come two years later, and every class has to stay affordable.
For a restaurant, a store or a staffing company with 50 or more people, this is a lifesaver.The calculator keeps the offer affordable, the 1095-Cs fill in as the year goes, and if a 226‑J comes, the answer is already on file.
Full-timers are counted the IRS’s way: part-timers’ hours add up toward the 50.
What the employer sees · 4 of 8
The proof, kept the day it happens
When someone declines, they sign the waiver right then, and the record shows the offer was affordable. Every offer, waiver and form updates as it happens. Nobody pays an attorney or an accountant to rebuild paperwork the company already had.
groups.benehive.tech/benefits/abc-corporation
Real screen, made-up company, sample numbers. We aren’t tax advisors: this is what the company brings to its accountant.
What the employer sees · 5 of 8
The 1095-C, filled in every month
Every month, each person’s form fills in from what really happened. Erin started in March: January and February say she didn’t work there yet. From March on, her offer, her cost and why there’s no fine.
A sample form for a made-up employee and company.
What the employer sees · 6 of 8
If a Letter 226‑J ever comes
The company uploads the letter. We read it, match each person on the IRS list to the company’s records, and put the answer together: the offer, the cost, the signed waiver and the right codes, one page a person. Their accountant sends it.
A sample response for a made-up employee and company.
What the employer sees · 7 of 8
What it costs to stay affordable
Pick what the company pays for each class. The calculator shows whether the coverage counts as affordable, what it costs to fix if it doesn’t, and the most the IRS fine could be, worked out step by step.
groups.benehive.tech/benefits/abc-corporation
Real screen, made-up company. Here the kitchen fails at 80%; the calculator shows it takes 85.13%.
What the employer sees · 8 of 8
The HRA, with no TPA fee
Employees send their claims from their own page. Benehive helps them organize the paperwork and takes out anything about the care. The company’s HRA administrator decides and pays from the company’s own account.
groups.benehive.tech/benefits/abc-corporation
Real screen, made-up company and people.
Ready for 2027: payroll
Payroll on the same page as the benefits
One pay run
Hours, salary and tips go in. Every employee gets their pay stub on their own benefits page.
Benehive pays everyone
Benehive is the payroll company. The company funds each payroll, and Benehive pays every employee by direct deposit.
The HRA on the paycheck
Any claim the company approves can go on the next payroll. It’s a reimbursement, not wages, so no taxes come out.
Taxes paid and filed
Benehive pays the payroll taxes and files the quarterly returns and W-2s as the company’s IRS reporting agent.
One set of records.The person on the payroll is the same person on the plan, on the 1095-C and on the HRA. Nobody types anything twice.
Payroll runs on Benehive for 2027, starting with New York and New Jersey.
Ready for 2027: payroll
Everything flows into their books
Every pay run
Posts as a journal entry: wages, every tax, every deduction.
Every HRA payment
Posts the day it’s paid, as a reimbursement.
Every premium bill
Posts each month, by plan and by class.
QuickBooks Online and Xero connect directly.Anything else gets a file export it can read. The company’s accountant sees the same numbers the company does, without anyone keying them in.
Payroll and the bookkeeping connections are ready for 2027.
Why your clients stay
Payroll keeps the client. Line items keep them happy.
How a PEO keeps a client
Everything blended into one bill, so nobody can see what each piece costs or take one piece somewhere else.
How you keep a client
Their payroll runs on Benehive, so they never want to leave. Every service is its own line, so they always see what they pay for.
When something gets too expensive
The health plan, the dental, even their card processing: we export the census, shop it, and plug the new one in for them.
You only have to worry about servicing your clients and keeping them happy.When one piece gets too expensive, you don’t lose the client. You find them a better one.
Payroll runs on Benehive for 2027.
The next step
Bring us a group.
Even one that can't get a waiver. Even one stuck in a PEO today.
Austin Smith
(845) 523-8270 · info@benehive.tech
Benehive · groups.benehive.tech
What your agency gets
Your own alternative PEO, under your name
GLP-1s covered. Guarantee issue for the sick. Level-funded for the healthy. PEO-style HR and payroll. One portal, under your agency's name.
Available now
Group health: level-funded and guarantee-issue plans, one price per tier
GLP-1s and wellness care through Curate Health
Dental and vision
The benefits portal for the employer and every employee, branded for your agency
Compliance and the affordability calculator
The HRA, run from the company’s own page
Coming soon
Payroll for 2027, run through Benehive, with the HRA on the paycheck
Workers' comp, paid with each payroll
HR help: handbooks, compliance and HR experts on call
FSA, HSA and COBRA administration
401(k) and background checks
Merchant services: card processing at a better rate
Utility audits: electric, gas and fuel bills checked for savings
Partner services are offered and provided by each partner, connected through each employer's benefits portal under your agency's name.