General Information
All full-time employees (30+ hours a week) must be offered an employer-sponsored healthcare plan.
An employee does not have to sign up for a PGC healthcare plan; it is completely optional.
If mutually agreed, a client can opt to offer a medical stipend instead, allowing the employee to sign up for any plan they wish.
However, the stipend is taxed as normal income - unlike a direct employer contribution.
The legal minimum contribution in 2026 is $336.15 per month with an added $25 fee for administration (except in San Francisco, with a minimum of $706.92). This part is mandatory in the contract and can not be taken out. This contribution can ONLY be used for the plans offered via PGC.
Most employers contribute a higher rate, with approximately 70-80% of the amount paid by the employer (p. 11) - Clients need to determine their contribution in advance and are free to choose.
A stipend can be recommended for any client who wants to make contributions in another manner. Stipends can be used for anything ex: Phone stipend, medical stipend, etc (see own provider in FAQ)
A contribution of $350-500 is quite common in the US, but depends on the level of contribution the client would like to make. In case the employee also want to cover their spouse or children, this amount may be higher.
PGC offered healthcare plan
U.S. talents under PGC are not enrolled in medical benefits from day one; a standard waiting period applies before coverage becomes effective.
Employees will fall under PGC’s Insurance - (certificate of insurance is available upon request).
PGC's health care plans are provided by Aetna or New York Life.
Some important terms associated with healthcare plans in the US are described in the image below (p.13):
Choosing the Healthcare Plan
The client determines the exact amount the employer would like to contribute to the employee's healthcare plan (regardless of the employee's choice).
The employee will then be notified during onboarding about the amount of the employer contribution that will go towards the partner's medical plan of the employee's choice (amongst the three available options). The amount will then be deducted from the Healthcare cost. In case, the cost of the plan is higher than the employer contribution, the remainder of the cost will be deducted from the employee's paycheck every month.
Other Benefit Plans
The other health-related benefit plans (Dental Plan, Vision Plan, etc.) are completely optional for employees and employers.
The client can also make a contribution via a "stipend", but that would be after-tax allowing no tax advantage. A "stipend" is only recommended if the client offers similar benefits in other countries.
The above-mentioned contracts are attractive for the employee even without the client's contribution and offer better conditions than comparable offers that are freely available to the employee (so they can be offered even without employer contribution).
If an employee would like to continue with their current plan that they had with their previous employer, they could opt into receiving COBRA Benefits. Cobra stands for 'The Consolidated Omnibus Budget Reconciliation Act.' This Act provides employees and their families, who have lost their health plan coverage, the right to choose to continue the group healthcare plan provided to them by their group health plan for limited periods of time under certain circumstances such as voluntary or involuntary job loss, reduction in the hours worked, transition between jobs, death, divorce, and other life events.
There is a 30-day waiting period before healthcare benefits can be availed.
Short Term & Long Term Disability, as well as, Life Insurance are provided through Cigna.
Medical Coverage Waiting Period & COBRA Guidance
30-Day Waiting Period for Medical Benefits
For all U.S.-based talents employed under PGC, a 30-day waiting period applies before medical benefits become effective. This structure is customary in the United States and aligns with standard market practice for employer-sponsored health plans.
What this means in practice:
The “first month of work” refers to the first full calendar month actively worked.
Coverage begins on the first day of the following month.
Example:
Start date: 15 June
First full calendar month worked: July
Medical coverage effective date: 1 August
This waiting period applies uniformly to all U.S. talents under PGC and cannot be waived. Making exceptions could be considered discriminatory and may jeopardise plan compliance. Ensuring consistency protects both the client and the integrity of the benefits structure.
Coverage During the Waiting Period
During this initial period, talents will not yet be covered under PGC’s medical plan. To avoid a coverage gap, they may choose to continue their previous employer’s health insurance through COBRA, if eligible.
What is COBRA?
COBRA stands for the Consolidated Omnibus Budget Reconciliation Act, a U.S. federal law that allows employees and their dependents to continue their previous employer-sponsored group health plan for a limited period after losing coverage due to qualifying life events.
Qualifying events may include:
Voluntary or involuntary job loss
Reduction in working hours
Transition between jobs
Divorce
Death
Other defined life events
Key COBRA Details
Election period: 60 days from the date prior coverage ends
Duration: Typically 18 to 36 months, depending on the qualifying event
Cost: The individual may be required to pay up to 102% of the full premium
Enrollment: Not automatic — the employee must actively elect coverage
Responsibility: The prior employer sends COBRA election information
Optional Client Stipend as an Interim Solution
To support talents during the waiting period, clients may choose to provide a temporary stipend to help offset COBRA costs. This solution is fully discretionary but can significantly enhance the talent experience during the transition.
Important Considerations
The stipend is optional and determined by the client.
It typically reflects the cost of one month of COBRA coverage.
The stipend is considered taxable income.
COBRA premiums are generally higher than active employee contributions.
The stipend should end once PGC coverage becomes active.
Once enrolled in the PGC plan, the talent’s pre-tax medical contribution will be reflected directly in the WorkMotion invoice.
If a stipend is provided:
PGC can reflect this arrangement in the Schedule Agreement Document.
The Schedule must still state that the employee is eligible for PGC’s medical plan and will receive at least the minimum pre-tax employer contribution toward a PGC medical option.
The partner will only pass through the minimum pre-tax employer contribution cost if the employee enrols in one of the partner’s medical plans.
FAQs
Is the Client allowed to offer the minimum health insurance contribution to some EEs and a higher contribution to other EEs, or must they offer the same contribution to all?
Yes. As long as the employer contribution amount is at least the statutory minimum, the client can offer different amounts for different workers. However, please inform/ recommend to the client that employees on the same tier/seniority should be offered the same amount of benefits to avoid any discrimination claims. The same conditions apply to the pension (401k).
Does the minimum health insurance contribution change, when the talent wants to include their family in the health insurance?
The client contribution is not contingent to the plan that the Talent selects. The client will set their contribution amount and that is the amount the Talent receives, regardless of the plan they choose - any additional payment is for the Talent to support.
Which plans does PGC offer?
There are 3 tiers to choose from Silver, Gold and Platinum, the only difference is the deductible (how much a worker has to pay out of pocket before insurance takes over) amount.
What is different when client chooses a medical stipend instead of one of the PGC plans?
A medical contribution is PRE-TAX, given directly to the plan and a medical stipend to allow them choose their own outside plan is TAXED as regular wages and given directly to the worker following their pay frequency.
How are Medicate and Medicare connected?
Medicare and Medicaid are state and federal programs that operate outside of PGC. PGC only offers private medical employer-sponsored plans. The worker would be responsible for researching and enrolling and would be completely separate from PGC.
Is there an age limit to the health care plans provided by PGC (Aetna or New York Life)?
No, not for medical insurance and if the worker is enrolling into life insurance at onboarding, they should be able to without a qualifying test. If they choose to not enroll as a new hire but instead waits until Open Enrollment at the end of the year, they will need to fill out qualifying forms for life insurance.
What happens if the talent wants to use their own health-care provider?
The minimum mandatory contribution has to stay in the PGC contracts, the client can only provide a stipend on top of the minimum contribution ( $336.15 per month with an added $25 fees for administration (except San Francisco with a minimum of $706.92). WorkMotion is only charged this minimum legal contribution if the talent were to enrol in a PGC-sponsored plan. However, even if talent and client have an agreement about not actioning this and provide a (higher) stipend instead, the client is always at risk, since the talent keeps the legal right to enrol.
Source:Workwell Global Open Enrollment 2026 - PGC Resources