group health insurance

What is group health insurance?

Group health insurance is coverage through an employer or other entity that offers coverage to all eligible individuals in the group. Before the Affordable Care Act, group health insurance coverage was more regulated than individual health insurance, although many of the law's provisions apply to both the individual and group markets.

Group health insurance includes both small groups and large groups, which have different regulations, as well as self-insured group coverage. In most states, "small-group" means up to 50 employees, although three states define small-group as up to 100 employees¹ (Colorado previously used the 100-employee threshold but switched to the 50-employee threshold in 2026).²

If an employer has more employees than the state's definition of small-group and chooses to purchase coverage (as opposed to self-insuring), the plan will be purchased in the large-group market.