Getting Started as a Benefits Agent & the Best Insurance CRM Solutions

Table of Contents

• What is a benefits agency
• The benefits of offering group benefits
• Understanding group health plans and markets
• 5 steps to launching a successful benefits agency
• The best CRM for benefits agencies
• Common questions about group benefits

What is a Group Health Insurance Benefits Agent?

An employee benefits agent or agency, also known as a group health insurance agency, helps businesses offer benefits to their employees, such as health, life, and disability insurance. Employer-sponsored plans cover about 154 million non-elderly Americans. This shows the value group benefits agents provide in helping organizations deliver reliable health coverage to their employees.

Instead of working with individuals, benefits agencies work with a business’s leadership, like the owner, HR team, executive team, etc. Often, benefits brokers call these businesses employer groups. The goal of the partnership is to align with the organization’s needs, budget, and compliance standards.

In this blog, you’ll learn more about what a benefits agency is and the role they play in employee health insurance. You’ll also gain an understanding of the critical tools you’ll need to support your agency’s growth — like an insurance CRM or agency management system (AMS).

The Benefits of Offering Group Insurance

Group benefits remain one of the strongest and most consistent markets in the insurance industry. If you're looking for ways to expand, adding group benefits can be a valuable addition to your agency’s services.

Here are a few reasons why your agency should consider offering group benefits, whether you’re just starting out or looking to diversify:

• High and recurring value: A single employer group can represent many employees and dependents, resulting in considerable upfront revenue for your agency.
• Room to expand your services: Managing a group’s medical plan is a great launch pad for offering additional coverage lines. Dental, vision, life, disability, and wellness benefits can increase revenue and build deeper client relationships.
• Rising interest in change: Twenty-nine percent of healthcare consumers say they plan to switch health insurance carriers in the next year.
• Long-lasting client relationships: Employers appreciate consistent service and guidance. When your agency supports their benefits needs well, they are more likely to stay with your agency.

Together, these benefits can make group coverage a valuable addition to your agency.

Understanding the Role of a Benefits Agent

A benefits insurance agent plays a crucial role in helping employers manage and maintain their employee benefits programs. Your agency will support both the business and the employees who rely on those benefits. With that in mind, let’s take a closer look at the role you’ll play in this process.

While your agency provides valuable support, it’s important to remember that your team acts only as an advisor. Here’s a breakdown of what employers are responsible for and how you can support them:

Employers are responsible for:

• Maintaining employment records and eligibility status
• Approving final elections and enrollment changes
• Distributing required notices under ERISA, HIPAA, and the ACA (more on these later!)
• Managing payroll deductions
• Ensuring compliance for their group health plan

Even though these are roles the employer group holds, there may be times you need to assist and advise them on best practices. Often, business executives will look to you as the expert who can help them choose the best path.

Your team will support them by:

• Providing plan guidance and helping employers evaluate benefits options
• Assisting with quoting, renewals, and carrier communication
• Helping HR teams understand enrollment timelines and qualifying event rules
• Supplying tools and processes that make documentation and plan management easier
• Supporting employees throughout the plan year with questions and coverage issues
• Offering ongoing service that ensures accuracy and smooth administration

With the role and responsibilities now defined, here are the key steps to launch and grow your benefits agency.

5 Steps to Launch Your Employee Health Insurance Agency

Launching a benefits agency requires focus and a well-defined plan. Use the steps below to get started with your group benefits agency and give your team a clear path to sustainable growth in employee benefits.

1. Get Licensed to Sell Employee Benefits

• Determine your license type: Selling employee benefits typically requires a Life and Health insurance license, though some states offer a Health-only option.
• Complete pre-licensing education: Fulfill your state’s required pre-licensing coursework through an approved provider and prepare for the exam with practice tests.
• Pass the state licensing exam: Successfully pass your state’s Life and Health (or Health-only, if applicable) insurance exam.
• Submit your state license application: Apply for your insurance license through your state’s insurance department or licensing portal.
• Complete a background check: Most states require fingerprinting and a background check as part of the licensing process.
• Maintain your license with continuing education (CE): Complete all required continuing education credits on an ongoing basis to keep your license active and in good standing. CE requirements typically apply every 1–2 years, depending on the state.

After completing these licensing requirements, you can start selling employee benefits and growing your employer client base.

 2. Understand the Basics of Group Benefits

Before you begin working with employer groups, it’s important to build a solid foundation. Focus on the fundamentals of group benefits to better support clients and deliver consistent service.

The Different Types of Group Benefits Plans

Part of building this foundation is learning about different types of  group health plans, how they are funded, and which employer groups they fit best. Your role varies depending on whether the plan is fully-insured, level-funded, or self-funded.

• Fully-insured: A fully insured health plan is one of the most common options companies use to provide coverage for their employees. The employer pays a set monthly premium to a health insurance carrier for all enrolled workers, and the carrier then pays for the employees’ medical claims. In most cases, employees contribute by paying a portion of that monthly premium.
• Self-funded: Self-funded insurance, also called a self-insurance plan, is a benefits arrangement where the employer covers most or all of the costs for employees’ claims. Although the insurance carrier handles the paperwork and processes the payments, the employer is the one who actually pays for the claims. These plans often require more detailed administration. Because of this, employers may rely more on your agency for help with plan design education, stop-loss coordination, and guidance on working with different vendors.
• Level-funded: Level-funded insurance plans are a hybrid form of group benefits coverage that combines features of both fully-insured and self-funded models. They give employers a steady, predictable cost structure while still delivering robust, comprehensive benefits to employees.

Understanding these differences allows you to tailor your service model and provide the right level of support to each employer group.

Key Regulations for Group Benefits

Compliance plays a central role in employee benefits. Knowing the various regulations and why they apply ensures your agency can provide accurate and dependable guidance to your employer groups.

Here are some of the most common and critical regulations you’ll find in group benefits:

• Employee Retirement Income Security Act (ERISA): Sets rules for plan documents, fiduciary duties, and reporting requirements. Most private-sector employer health plans follow ERISA, though some, such as certain government and church plans, are exempt.
• Health Insurance Portability and Accountability Act (HIPAA): Protects employees’ health information and defines how medical data must be stored, used, and shared.
• Affordable Care Act (ACA): Establishes essential health benefits, rating rules, employer coverage requirements, and annual reporting standards. With ACA coverage, there are two common compliance documents: the ACA Consent to Contact and the ACA Attestations.
• Consolidated Omnibus Budget Reconciliation Act (COBRA): Requires certain employers to offer temporary continuation of coverage when an employee loses eligibility.
• Mental Health Parity and Addiction Equity Act (MHPAEA): Requires plans that include mental health or substance use benefits to cover them at the same level as medical and surgical benefits.
• Summary of Benefits and Coverage (SBC): Requires employers to provide employees with a standardized, easy-to-read summary of each health plan.
• State Insurance Regulations: These vary by state and may define plan design, required benefits, and participation rules.

When you understand these regulations well, you’re able to give clients better advice, help them avoid potential issues, and make the entire benefits process easier for them to manage. For more helpful definitions, check out our benefits terminology blog.

3. Establish Your Agency’s Focus Area

Once you have a solid understanding of group benefits, the next step is to define your focus.

Start by choosing the types of employers you want to work with. Many agencies begin with small groups and expand over time. Others choose to specialize in specific industries, such as non-profits, medical practices, construction, or schools.

Because the group market includes both small- and large-group categories, each offering different benefits and limitations, it’s important to know which segment your clients are in. That insight allows you to point them toward the most suitable coverage. Learn more about how employer size affects plan options.

Another choice you’ll need to make is whether to offer full-service benefits or start with ancillary lines. Here’s what each option looks like:

Full-service benefits: the core employee benefits package. A full-service benefits package usually includes medical, dental, vision, and major life/disability. Some things to know about selling full-service benefits:

• More complex to administer
• Higher premiums and compliance requirements
• You act as the primary benefits advisor

Ancillary lines: add-on or supplemental products. Ancillary products usually include insurance coverages like,  accident, critical illness, hospital indemnity, voluntary life, etc. Some key things to know about selling ancillary coverage:

• Usually lower cost and often employee-paid
• Easier to implement, lighter service needs
• Good for filling gaps or starting small

A clear focus helps you create your brand. This leads to more effective marketing, quoting, and service processes.

Build Strategic Partnerships

Strategic partnerships are a powerful way for your agency to generate referrals and grow your group benefits agency. By supporting professionals such as CPAs, payroll providers, HR consultants, PEOs, and property & casualty agencies, your agency can expand its employer network while delivering added value to clients.

Successful partnerships depend on:

• Choosing the right partners
• Setting clear expectations
• Maintaining consistent communication

• Provide access to multiple carriers, allowing your agency to offer competitive options and more comprehensive solutions.
• Deliver training and ongoing education, so your team stays knowledgeable, confident, and prepared to advise clients.
• Support compliance and regulatory needs, helping reduce risk and protect your agency as requirements change.
• Offer strategic guidance aligned with your agency’s goals, whether that’s growth, specialization, or improving operational efficiency.

Choosing an upline that truly supports your agency can make all the difference in how effectively your team serves your clients.  They should bring real-world experience to your agency.

4. Get Appointed with Carriers

Once your upline is in place, you can move forward with contracting carriers that fit your target employers and product offerings. Secure appointments with the insurance carriers whose group products you plan to offer, often with support from an upline or general agency.

Take time to get familiar with each carrier’s:

• Plan designs
• Quoting rules
• Underwriting guidelines
• Renewal timelines

This knowledge will help you give more accurate advice and avoid surprises during the quoting or renewal process.

5. The Best Tools for Group Benefits Agents

Equipping your benefits agency with the right tools from the start creates a solid foundation for efficiency and helps your team maintain compliance while delivering a smoother, more reliable client experience.

A Reliable Quoting & Enrollment Tool

A quoting and enrollment system is essential for comparing group health plan options quickly and accurately. The right tool should help your agency:

• Review plans from multiple carriers in one place
• Collect and organize census data without errors
• Easily compare plans and pricing
• Handle underwriting and submissions
• Build professional proposals
• Support employee enrollment

Empower your team with top of the line tools, like Quote+, to simplify carrier comparisons and deliver the best plan options to your clients. Compare community-rated and medically-underwritten plans, plus ancillary benefits, in one place.

An Industry-Focused Agency Management System (AMS)

Managing multiple employer groups, employees, policies, and renewal cycles requires the right structure. To stay efficient, your growing benefits agency needs a system built specifically to manage group benefits. An industry-focused AMS like AMS+, an AgencyBloc solution, gives your teams one centralized place to:

• Store employer groups, employees, dependents, and all medical, dental, vision, life, disability, and ancillary policies in one secure location.
• Manage group and employee records, including dependents, policy details, and key client information.
• Automate onboarding, renewals, follow-ups, compliance tasks, and life-event updates using workflows that prevent missed steps and save time.
• Keep communication organized with stored emails, notes, tasks, and documents tied to the correct group or employee.
• Provide clear reporting and analytics to track renewals, policy changes, daily activity, client engagement, and overall agency performance.
• Maintain compliance with permission controls and an audit-ready history.
• Connect with a quoting tool like Quote+ and compare plans across carriers, build proposals, and manage enrollments in one place.

Having an industry-specific system will help your team work more accurately, stay consistent, and deliver a higher level of service to every employer group you support.

FAQ: Common Questions About Getting Started in Group Benefits

To help you better support your agency, we’ve compiled answers to some of the most common questions about getting started with group benefits.

1. What are group benefits? Group benefits are employer-sponsored insurance plans such as health, dental, vision, life, disability, and ancillary coverage. They help protect employees’ health and finances and are usually more affordable than individual plans.

2. Why should your agency offer group benefits? Offering group benefits helps your agency grow by expanding revenue and improving client retention. It also allows you to offer competitive solutions, build long-term business relationships, and stand out in the market.

3. What is a group census and why is it important? A group census is a detailed roster of all employees (and eligible dependents) within a company who may receive group benefits. It typically includes:

• A list of all eligible employees and any dependents
• Each person’s age or date of birth
• Their gender
• Their ZIP code
• The benefits they plan to enroll in and the ones they are choosing to waive

Brokers use this census data to generate accurate premium quotes, determine who qualifies for coverage, and assess the overall risk of the group. Without complete or accurate census data, the quoting process can be delayed.

4. What role does an agent play in group benefits? Benefits agents evaluate what an employer needs and help compare different carriers and plan options. They also offer guidance on compliance requirements and support the enrollment process. Throughout the year, they provide ongoing assistance and help develop strategies for renewals.

5. What are the enrollment periods for group health insurance? Group health insurance includes specific enrollment periods that determine when employees can sign up for coverage, make changes, or update their benefits. The main enrollment periods include:

1. Initial Enrollment: This is the first chance for a newly eligible employee to enroll in the group health plan. It usually takes place soon after starting a new job, and employees have a set amount of time to select their coverage.
2. Open Enrollment: Once a year, employers hold an Open Enrollment period when all eligible employees can join the plan, review their options, or make changes to their existing coverage. It is the best time to reassess benefits and choose the plan that fits current needs. Not sure what to communicate? Use these free email templates!
3. Special Enrollment Periods: Certain qualifying life events (QLEs), including marriage, the arrival or adoption of a child, or losing other coverage, can open a Special Enrollment Period. Because of a QLE, employees and their dependents can update their coverage outside the regular enrollment schedule.

Enrollment deadlines can vary depending on the employer and the carrier. It’s important for your agency to be aware of these timeframes so you can better support your employers and their employees.

6. How can agencies streamline their group benefits?  Your team can simplify your agency operations with an industry-specific AMS, like AMS+, paired with a small group quoting and enrollment tools, like Quote+. Quote+ gives small group brokers and GAs all the tools needed to manage quoting and enrollment from start to finish in one connected workflow. Used together, AMS+ and Quote+ help reduce administrative work and improve overall service quality.

Posted by Shannon Beck on Tuesday, December 16, 2025 in Group Benefits