In Maryland, DC, and Virginia, you can offer small-group health insurance with as few as two enrolled employees (one employee and one owner counts). Group plans become available, more carrier-competitive, and more plan-design flexible as you grow toward 50 employees. At 50 full-time-equivalent employees, the Affordable Care Act’s Applicable Large Employer (ALE) mandate kicks in — you must offer affordable, minimum-value health coverage to full-time employees or face shared-responsibility penalties. We help small employers evaluate whether offering group medical, an ICHRA, or no employer-sponsored health is the right starting point.