Four ways to price an employer contract are per enrolled member, per eligible employee, by family tier, or one flat fee. Each one moves risk between you and the employer in a different way. Pick the one that matches how the group will enroll and how sure you are about usage.
Per enrolled member
The employer pays for each person who signs up. Simple and fair, and it matches the way individual members pay. Your revenue moves with enrollment, so it can change each month.
Per eligible employee
The employer pays for every eligible employee, whether or not they enroll. Lower price per head, steadier revenue, and no monthly argument about who signed up. The employer may push back on paying for people who don't use it.
Family tiers
A price for employee only, employee plus spouse, employee plus children, and family. Watch the family tier against your costs and, if HSAs matter to the employer, against the $300 limit. More on dependents.
Flat monthly fee
One fee for the whole group, which can include an enrollment band, like up to 50 members. Easy to bill. You carry the risk if enrollment or usage runs higher than you expected.
Compare them on one example
In a made-up example, an employer has 60 eligible employees. You expect 36 to enroll, plus 12 dependents.
- Per enrolled member at $70: 48 members, $3,360 a month.
- Per eligible employee at $45, dependents at $35: 60 times $45 is $2,700, plus 12 times $35 is $420, for $3,120 a month.
- Flat fee of $3,300 for up to 55 members.
Any of these can work. What matters is that each one stays above your floor price under the enrollment you expect and under a higher one.
What it changes in your books
Per enrolled member needs a monthly roster. Per eligible employee needs the census. A flat fee needs only a contract. Whatever you pick, record it on the employer revenue line and keep the contract list current.
What I'd do this week
- Price your next proposal two ways and compare.
- Test each price at expected enrollment and at 20% higher.
- Write down which model each current contract uses.
Common questions
Which model is most common?
I haven't seen a reliable count. Per enrolled member is the easiest to explain.
Can I change models at renewal?
Yes, if the contract allows it. Bring the usage numbers to show why.
Should dependents cost less than employees?
They can, if they use less care. Price on what you see.
Want to test a price before you quote it?
We reconcile every account every month and send your P&L and Balance Sheet by the 15th, so decisions like this start from real numbers. If that's what you need, apply to work with us.