What should a startup benefits package include?

The core package

My priority is to make core benefits understandable before buying extra perks. Show the employee-only and family payroll deductions, maximum covered cost sharing, provider network and prescription rules. Then explain retirement contributions and leave in separate terms. Different candidates have different priorities; I would not assume a single survey percentage captures your team's preferences.

What to offer at each stage

The sequence is my planning framework, not a legal schedule tied to those headcounts. A state retirement requirement or employee leave obligation can arise earlier. Quote each benefit, assign an owner and decide what the company can maintain through growth or a difficult renewal. A small list that works reliably is easier to communicate than an uncosted list of promises.

What a 15-person package costs

Qualified employer health coverage generally receives favorable federal tax treatment, while Section 125 rules can allow eligible employee premium contributions before tax. Owner and other exceptions matter. KFF's 29% statistic describes covered workers at small firms whose employer pays the entire single premium, not 29% of all small firms. I would label that denominator whenever using it in a benefits comparison.

2026 limits for tax-advantaged benefits

What candidates actually compare

I would make these five questions easy to answer before a candidate or employee has to ask. Use the actual documents and contribution schedule, and give people a private route to check their provider or medicine:

1. What will I pay each month for myself, and for my family? Show the employee's share in dollars, not percentages.
2. What are the deductible and maximum? Show family and individual rules, covered services before the deductible and the reset date. A premium contribution alone does not establish the cost of care.
3. Is my doctor in network? Especially for anyone in therapy, pregnant or managing a chronic condition.
4. Is there a 401(k), and is there a match?
5. What's the parental leave policy? Write it down before someone asks.

Ask employees which optional benefits they would use, with no pressure to disclose medical conditions or family plans. Compare participation and service feedback after launch. I would keep separate budgets for core coverage and optional perks so a change in one does not silently reduce the other.

Mental health without a separate vendor

Start by checking therapy, psychiatry, medications and network access in the actual medical plan. Federal mental health parity rules, when applicable, govern financial requirements and treatment limitations using classification-based tests; they are more specific than a promise that every service has identical coverage. Non-grandfathered individual and small-group policies also have essential-health-benefit requirements. Have the administrator confirm the applicable rules. Ask how a member finds an available appointment and appeals a denial before buying another app.

Ways to offer medical at a startup

If ICHRA fits your team, I recommend comparing Prescience Choice first. Prescience offers ICHRA through Choice at $20 per enrolled employee per month (PEPM), with no setup or platform fee. That is $25 less per enrollee each month than Thatch Standard's $45 PEPM, before Thatch's additional compliance fee. Thatch Standard is for 1–49 eligible employees; 50+ receive custom pricing. Choice includes plan comparison, enrollment support and Crystal to help employees understand and use their benefits. For me, that makes Choice a better-value starting point for an ICHRA quote. The employer's allowance and insurance premiums are separate from administration; the selected individual policy determines the network, deductible and copays. Ask us about Prescience Choice.

• Small group plan directly from a carrier or through a broker. Pooled ACA rates; you choose the plan. See how carriers price health insurance.
• PEO. Access to a large-company plan, bundled with payroll and HR. Watch for first-year pricing and exit terms. See is Rippling PEO worth it.
• ICHRA or QSEHRA. You give a tax-free allowance and employees buy individual plans. Flexible, but quality depends on your local individual market. See is ICHRA a scam.
• Taxable stipend. Simple but inefficient: the money is taxed as wages. See health insurance stipend.

Edge cases founders hit

• Remote employees in other states. Make sure the network works where they live, and check state leave and payroll rules for each state you hire in. See health insurance for remote employees.
• Contractors. Including 1099 contractors in a group health plan can create employment-status questions. See health insurance for contractors.
• Waiting periods. A group health plan generally cannot impose more than 90 days once a worker is otherwise eligible. Check the written eligibility conditions and the actual enrollment date instead of assuming that three calendar months equals 90 days.
• Founders only. Some carriers require at least one non-owner employee for a group plan. Check before you hire your first person.
• People who decline. Carriers set minimum participation, often counting employees with other coverage as valid waivers. See can employees opt out.

How to roll it out

1. Set a budget per employee Set employee-only and dependent contributions. A fixed amount limits the contribution per enrollee, but total cost still changes with hiring, tier changes and administration.
2. Quote medical first Get at least two quotes of different kinds. Medical decides most of the budget.
3. Set up a Section 125 plan Have the administrator establish and operate a written Section 125 arrangement if appropriate. Confirm eligible participants, payroll deductions, election rules and nondiscrimination responsibilities.
4. Add dental, vision and retirement Compare providers, payroll compatibility, fees and employee access. Ask the tax adviser to determine whether any retirement startup credit is available; do not subtract it before eligibility is established.
5. Write it down and explain it One page per benefit: what it costs the employee, what it covers, how to use it. Put total compensation, including benefits, in offer letters. See how to run open enrollment.

Getting the medical plan right

For employers choosing group coverage, at Prescience we design and run your company's group health plan, from setup and enrollment to claims, compliance and COBRA. What your team gets:

• An effective $0 deductible, so the plan helps from the first visit.
• Simple copays shown before a visit, capped by a low out-of-pocket maximum.
• A broad national PPO network, plus providers we contract with directly.
• 24/7 physician-led care navigation: a care team that finds the right provider, books appointments and explains costs up front.

What your company gets: one monthly cost set in your quote, usually 10–20% below comparable fully insured coverage and fixed before the plan starts, with no admin fees. You keep your payroll provider, and the plan can start mid-year.

Reconcile the package before the first payroll

I would assign one person to reconcile employee elections, carrier confirmations and payroll deductions before coverage starts. Have that person check a single enrollee, a family enrollee and someone who waived coverage. Confirm the effective date, contribution formula and number of pay periods. A monthly contribution divided into twenty-four payments produces a different deduction from the same contribution divided into twenty-six.

Give employees one contact for enrollment corrections and a separate private route for clinical or claims questions. Save the final benefit summaries, contribution schedule and vendor responsibilities together. Review the first invoice against actual enrollment rather than the original quote census. This catches administrative differences before the company uses the new package as its benchmark for the next hire.