The model you're in wasn't designed for you.
The fully insured cycle
Every year, the same story. Premiums are up — 8%, 12%, maybe 20%. You negotiate. You shift cost to employees. You raise deductibles. Maybe you switch carriers and disrupt everyone's providers to save 4% that gets eaten by next year's increase anyway.
The self-funded trap
Stop-loss premiums, TPA fees, PBM contracts, claims analytics, utilization management. You've built an infrastructure to control costs — and some years it works. Other years, three expensive claims wipe out everything you saved.
Meanwhile, your employees pay for it.
They're on a plan they didn't choose, from a carrier they didn't pick, with a network that may or may not include their doctor. They pay more every year for coverage they didn't design and don't fully understand. And if they leave — no continuity, no portability, nothing they can take with them.
The employer pays too much. The employee gets too little. The broker renews the plan and moves on.
There's a different model. It's called ICHRA, and it changes the fundamental structure of how employers fund health benefits.
What ICHRA actually is — and why the economics work.
ICHRA — Individual Coverage Health Reimbursement Arrangement — flips the traditional model. Instead of choosing a group health plan and enrolling everyone in it, the employer sets a defined monthly contribution. Employees use that contribution to purchase their own individual health insurance plan from the open market. The employer funds the benefit. The employee chooses the coverage.
The reimbursement is tax-free to the employee and tax-deductible for the employer. The economics work because you're removing the overhead, risk, and administrative complexity of group coverage and replacing it with a defined contribution toward individual plans that are community-rated and guaranteed issue.
ICHRA has been available under federal rules since 2020. Whether it is a practical fit depends on employee classes, local individual-market options, affordability, administration, and how the offer affects employees' potential premium tax credits.
For the employer
Cost predictability. No surprise renewals. No underwriting. No stop-loss. No risk.
For the employee
Choice. Pick the carrier, network, and plan that fits your family. Portable if you leave.
Tax advantage
Tax-free to the employee. Tax-deductible for the employer. ACA-compliant.
Most brokers avoid ICHRA. Here's why.
Implementing ICHRA requires two things your broker probably can't do at the same time.
On the employer side, someone needs to design the benefit — set contribution levels, define employee classes, choose a TPA, ensure ACA compliance. Most benefits brokers can handle this part, or they can learn.
On the employee side, someone needs to sit down with every employee and help them pick an individual health plan from the marketplace. That means understanding carriers at the individual level, calculating how the ICHRA contribution interacts with plan costs, checking provider networks, verifying formularies, and walking people through a process most of them have never done before. This is individual market expertise — and most brokers don't have it. They sell group plans. Their entire business is built around group coverage. They don't have licensed agents who work the individual marketplace every day.
So what happens? The broker outsources the enrollment to an ICHRA vendor platform. The employees talk to a call center, or a chatbot, or they navigate a self-service portal on their own. And the broker adds $20–40 per employee per month on top of the administration cost to cover the gap — because they're paying someone else to do the part they can't.
Now the employer is paying more than they need to for administration, and the employees aren't getting the guidance they were promised. The broker designed the benefit but can't actually service it.
"That's not a people problem. It's a structural problem. The typical benefits agency isn't built to operate on both sides of an ICHRA."
We already work both sides.
Nexus is a health insurance specialty firm. Benefits is all we do — not a product line alongside property, casualty, and auto. We don't divide attention across six disciplines. We go deep in one.
That means we already have a full individual marketplace practice. Hundreds of ACA clients across Michigan — small business owners, sole proprietors, early retirees, families. We know Priority Health, Blue Care Network, and every individual carrier in the Michigan market at the plan level. We help people pick individual health plans every single day.
When we implement ICHRA for an employer, the same firm that designs the benefit is the firm that sits down with employees and helps them use it. No handoff to a vendor. No call center. No chatbot. Your employees meet with a licensed advisor in Grand Rapids who walks them through their options, checks their doctors, verifies their prescriptions, and makes sure they're enrolled in the right plan.
For administration, we size the solution to your needs. If you're a straightforward group of 15 employees in one location, we work with a local TPA, get your plan documents set up, and the administrative cost is minimal. You don't need a $30-per-employee technology platform for that. If you're larger with multi-state employees, we partner with a TPA that handles compliance across jurisdictions while our team here manages the enrollment experience for your people.
We don't sell technology for the sake of selling technology. We don't inflate the cost of an ICHRA so the broker can make money while someone else does the work. We do the work.
ICHRA isn't always the right answer. Here's how we think about it.
We're not an ICHRA vendor. We're benefits advisors. If ICHRA is the best fit for your organization, we'll help you implement it. If it's not, we'll tell you that and find the model that is.
ICHRA tends to work well when the employer wants cost predictability without claims risk, when the workforce is geographically distributed and a single group plan creates network problems, when premium increases have outpaced the value employees are getting from coverage, or when a self-funded employer discovers they're spending significant resources on infrastructure without consistently beating what the individual market offers.
ICHRA may not be the right move right now if the transition would disrupt a workforce that isn't ready for the change, particularly if most employees are older and less comfortable navigating the individual market on their own. It's a paradigm shift from what people are used to, and the lift matters. That said — with the right enrollment support, even a workforce that's never shopped for individual coverage can make the transition successfully. That's what our hands-on enrollment process is built for.
There's also a scenario where ICHRA isn't the right play for a different reason. If you're a smaller employer and your employees are lower-wage workers who already qualify for strong marketplace subsidies on their own, offering an ICHRA can actually disqualify them from those subsidies. In that case, the smarter move may be to leave the medical coverage alone — let your employees keep their subsidized marketplace plans — and redirect your benefit dollars toward ancillary coverage that adds real value: dental, vision, life, disability, voluntary benefits. Your employees get a richer total benefits experience and your dollars go further because you're not competing with subsidies the government is already providing.
That's the kind of recommendation that only comes from a firm that actually understands the individual market. A broker who doesn't work the marketplace side wouldn't even think to analyze the subsidy interaction.
The bottom line: we'll model ICHRA against your current approach with real numbers from your actual census. If it saves you money and gives your employees better coverage, we'll help you implement it. If it doesn't — or if the timing isn't right — we'll tell you that and we'll talk about what it would take to get there when you're ready.
The future of employer health benefits is defined contribution.
Right now, most employers choose a health plan and put everyone on it. That's been the model for decades. But it's the same as if your company chose one bank, one mortgage, and one auto insurance policy for every employee. It doesn't make sense — and employers are starting to realize it.
The future is the employer funds the benefit and gets out of the plan selection business. Employees choose coverage that fits their own lives — their doctors, their families, their priorities. The employer's role shifts from plan administrator to benefit funder. Less risk. Less overhead. More value.
ICHRA is how that transition happens. Some organizations are ready for it today. Others need time — a year of planning, employee communication, and cultural shift. We meet you wherever you are on that spectrum. If the future is now, we'll build it with you. If it's next year or the year after, we'll help you lay the groundwork so the transition is smooth when the time comes.
Common questions.
Let's see if ICHRA fits your organization.
No commitment, no pressure. We'll model ICHRA against your current plan using your actual census and contribution levels, and show you what the numbers look like. If it makes sense, we'll build it. If it doesn't, we'll tell you that too.