Running a first group plan in Indiana is a sequence, and the sequence is fixed. You settle who is eligible, build a census, collect quotes, choose a funding shape and a plan, set your contribution, put a written plan document in place if the employee share comes out before tax, run an enrollment, and land on an effective date. The first two steps are the ones that get skipped.
Settle who is eligible before anyone quotes anything
Eligibility is a decision you make, not one the insurer hands you. Which employees are offered coverage, how many hours a week someone works before the offer reaches them, whether new hires wait, and whether the offer extends to spouses and children — those are your terms, and they need to exist before a census can be built, because the census is a list of the people your own rule includes.
Employers skip this because it feels administrative. It is not. Change the eligibility rule after quotes come back and every number behind them changes with it, because a different set of people is being covered. HealthCare.gov’s SHOP overview frames the same choices as employer decisions: whether to offer one plan or several, whether to offer health, dental or both, how much you pay toward premiums, and how long new employees wait before enrolling.
Write the rule down in plain words before anything else happens. If you would rather talk it through than draft it cold, that is exactly what our first group health plan service is for.
The census is the document that turns a question into a number
No insurer can price anything until it has a census. It is a list of the people eligible under the rule you just wrote — date of birth for each, who is eligible for family coverage, and where the business operates from.
Dates of birth are on there for a specific reason: age is one of the factors a small-group rate is permitted to move on, so the ages of the people you are covering are an input rather than a detail. The business address is on there because the rating area in the small group market is read off the employer’s own principal business address rather than off where each person lives, which is why the Indiana page spends time on counties.
Quotes can come back built on more than one funding basis, and those are not the same product even when they arrive in the same envelope. That difference is worth understanding before you compare anything, and our group health page is where we lay it out.
Guaranteed issue carries a qualifier written into the same section
Your group cannot be turned away because of who is on it. Under 45 CFR 147.104, an issuer offering coverage in the small group market “must offer to any individual or employer in the State all products that are approved for sale in the applicable market, and must accept any individual or employer that applies for any of those products.” Nobody’s health history gates whether your business can buy.
The same sentence opens with three words that matter: “subject to paragraphs (b) through (d).” Paragraph (b) is where the participation and contribution rules live. It contemplates a small-group plan that “cannot comply with employer contribution or group participation rules for the offering of health insurance coverage, as allowed under applicable State law,” and allows an issuer in that case to restrict availability to an annual enrollment window rather than writing the group whenever it applies.
So both halves are true together. You cannot be declined for your employees’ health. You can still be told that a group which does not meet a participation or contribution requirement has to wait for a window. Anyone who gives you only the first half has given you half a rule.
Real-World Scenario: An owner chose a plan first — she had seen it at a previous employer and wanted the same one — and asked us to get it quoted. Part of her team worked part-time hours and she had not decided whether they were in or out. Neither had her partner. When they finally settled it, the census changed, the mix of who was enrolling changed with it, and the comparison she had already made in her head no longer described the thing she was buying. Redoing the census was quick. Deciding the rule behind it was what had actually taken the time.
Your contribution is a decision, and it is also a requirement someone will check
How much of the premium your business pays is your call. That it is a real gating condition, rather than a preference, is the part first-time buyers do not expect.
Minimum employer contribution and minimum group participation are genuine requirements in this market, they are applied by the insurer, and the level is not one national figure. Federal regulation confirms they exist and that they follow state law where a state sets one; where it does not, they follow what insurers in that state customarily use. We name them as requirements and stop there, because there is no single number that is right across the nine states we are licensed in, and quoting the federally facilitated SHOP figure as though it were general guidance would be wrong more often than it is right.
The related mechanism worth knowing is how participation is counted. It is measured against the employees you offered coverage to, and people who already hold coverage somewhere else — another employer’s group plan, or government coverage — count toward the requirement rather than against it.
Section 125 is a plan document, not a payroll setting
If your employees are going to pay their share before tax, there has to be a written plan. A cafeteria plan under Section 125 is described by IRS Publication 15-B as exactly that: a written plan that lets employees choose between cash or taxable benefits and certain qualified benefits, with accident and health benefits among the qualified ones.
The consequence is blunt. With that document in place, the employee share can come out pre-tax. Without it, it comes out after tax, no matter what the payroll system is set to do — software will run the deduction either way and will not ask whether the paperwork exists. Sort it during setup, not in the first quarter of the plan year when somebody notices.
The marketplace serving Indiana is the federal one
Indiana does not run its own exchange. Indiana residents use the federal Health Insurance Marketplace at HealthCare.gov, and the state’s own program describes Indiana Navigators as people who help consumers complete federal Marketplace applications there. There is no separately branded Indiana exchange to go looking for, and no Indiana-only portal a first-time employer is missing.
What does exist federally is SHOP, defined at 45 CFR 155.20 as a Small Business Health Options Program operated by an Exchange through which a qualified employer gives employees access to qualified health plans. Because an Exchange may be run by a state or by the federal government, how SHOP looks is a state-level question rather than one national answer — and HealthCare.gov notes that an eligible employer can begin offering SHOP coverage at any time of year and can work through a SHOP-registered agent or broker.
Your group plan is a contract your business holds with an insurer. That stays true whether or not you ever open a federal website.
A small employer wellness statute that is still in the code, and a credit chapter that is not
Indiana keeps a chapter called Small Employer Wellness Programs at IC 16-46-13. It directs the state health department to set minimum standards for such a program and to certify a qualifying one as a qualified wellness program, and an employer may submit its program for that certification. The chapter is unrepealed in the 2026 Indiana Code.
Read the next clause, though. The certification exists “for purposes of IC 6-3.1-31.2”
— and in that same 2026 code, that chapter appears as expired. The program is on the books; the thing the certification was built to unlock is not.
We are not going to tell you Indiana offers a small-employer wellness incentive, because the record does not support it. We are also not going to tell you Indiana has nothing, because that is a claim too and we could not confirm whether the health department still certifies programs. What we can give you is the statute, the cross-reference, and the expiry, which is enough to decide whether it is worth a call.
The enrollment window, the effective date, and the cards
The last stretch is the most mechanical and the easiest to underestimate. Every eligible employee makes an election and records it, including the ones who decline — declines are part of the file, because participation is measured against who was offered coverage. People enrolling say whether they are covering family. The completed file goes to the insurer, and an effective date is set.
Cards and plan materials follow the effective date rather than the application. Between signing and cards arriving there is a gap, and it is worth telling your team about it in advance so nobody thinks coverage failed to start.
Then the plan year runs, and before it ends you will be doing a different exercise — reading a renewal instead of building a first plan, which is its own discipline and has its own service page. The other lines usually get added at the same time: dental, vision, life and disability. If you want to start the sequence, send us a census or reach the office directly; if you would rather know who you are dealing with first, that is our page, and the full list of states we work in is there too.
The bottom line
A first Indiana group plan runs in a fixed order — eligibility, census, quotes, funding shape, contribution, plan document, enrollment, effective date — and the steps that get skipped are almost always the first two.
Frequently asked questions
What should we make of the Indiana small employer wellness program statute?
Read it with its cross-reference. IC 16-46-13 is unrepealed and directs the state health department to certify a qualifying small employer wellness program. But the certification is written as being for purposes of IC 6-3.1-31.2, and that chapter appears in the same 2026 code as expired. We do not tell employers Indiana offers an incentive here, and we do not tell them nothing exists. That is what the code supports.
Do we need a Section 125 plan document before the first payroll deduction?
If the employee share is to come out before tax, yes — a cafeteria plan under Section 125 is a written plan, and IRS Publication 15-B describes it that way. Without that document in place, contributions are taken after tax. It is the step most often discovered late, because payroll software will happily run a deduction whether or not the paperwork behind it exists.
Is a group plan bought on the same website an employee would use for their own coverage?
No. An employee buying coverage for themselves uses the federal Health Insurance Marketplace at HealthCare.gov. A group plan is a contract your business holds, placed through an agent or broker with an insurer, and the employer is the policyholder. The two run on different tracks, and being eligible on one says nothing about the other.
We have never run a benefits enrollment. What does the first one involve?
Every eligible employee makes a choice and records it, including the ones who decline. Those who enroll pick a plan where you have offered more than one, and say whether they are covering family. Declines matter as much as elections, because participation is measured against who was offered coverage. The paperwork then goes to the insurer and the effective date follows.
Can we set a waiting period for new hires, or is that fixed?
It is one of the employer choices HealthCare.gov lists in its SHOP overview — deciding how long new employees wait before enrolling sits alongside choosing how much you pay toward premiums and whether dependents are offered coverage. We do not publish a maximum here, because the sources we work from do not carry one. Ask the insurer what its product allows before you write it into a handbook.
About the author
Nate Jones, CPCU, is the founder of Wexford Insurance and Wexford Health Insurance, an independent agency placing small-business group benefits in 9 states. Nate walks Indiana employers through a first group placement in sequence, because the decisions that look administrative — who is eligible, and what the plan document says — are the ones that send a first plan back to the start. Start with the Wexford Health Insurance quote form.