This only applies to large employers. Smaller ones are just presentef a limited list of plans to pick from, and the plans change every year. Most of the time, as a startup, you can’t buy a Mag7 equivalent health plan for any amount of money off the marketplace
It depends. If your employer is part of a self-funded group of other employers, then there is a group of trustees from all the employers that can approve.
If it's a 'fully insured' group plan then the insurance company is technically in charge, but your company can do an Employer-paid exception (aka carve-out reimbursement) to cover something thats getting rejected. They also have the option to purchase add-on policies to add coverage for upper class stuff like fertility treatments, weight loss drugs, or gender-affirming care.
Mag7 surely is self insured. They have an amazing risk pool of young people. Probably biggest cost is babies. So in this way employer sponsored health insurance screws the rest of the market, as it "hordes" the best risks. The insurance companies then wail about the cost of the risker pool of those of us stuck in the smaller plans...
There should only be one risk pool which is the whole country. Unfortunately the republicans want to go the other way and push sick people into high risk pools which will be unaffordable for a lot of people
