Finding the right group health plan for your business can be downright intimidating: sift through lists of insurance companies and plans; verify and re-verify dollars and totals for deductibles and copays; make sense of plan limitations and exclusions; deciphering the value of a dictionary of insurance jargon. It’s enough to make anyone feel like a high school freshman again.
Texas insurance law allows for a wide range of health care coverage plans and packages. All group health insurance has its limitations, and finding the right employee health plan at the right price can be challenging.
In Texas, the term “small employer” is a special insurance designation reserved for businesses with two to 50 eligible employees. The law provides some additional protections for these businesses, including a 15 percent annual cap on rate increases due to health factors, a state-mandated guarantee that providers cannot arbitrarily discontinue coverage, and a purchase provision. cooperative that allows small employers to pool their buying influence to negotiate lower rates.
For employees of small businesses in Dallas, Houston and throughout Texas, the law provides several ways to keep benefits after leaving a job and limits the waiting period before pre-existing conditions are covered.
Beyond these requirements, small employer insurance companies can offer a wide variety of plans, with virtually any combination of features and benefits.
Small Business Coverage Eligibility
Texas businesses with between two and 50 eligible employees can get small employer coverage from a traditional insurance company or a health maintenance organization (HMO). Eligible employees are defined as those who normally work at least 30 hours per week; are not classified as temporary, part-time or seasonal; and are not already covered by another group health plan. The owners of a business count towards the total number of employees.
The number of eligible employees, not the total number of employees, determines whether a business is considered a small employer under Texas insurance law. For example, if your business has 60 total employees, you might still qualify if six of the workers are part-time and four have coverage through some other source, such as a spouse’s plan.
If you decide to offer a group health plan to your employees, you must make it available to all of your eligible employees and their dependents equally.
Coverage is available under a small employer health benefit plan if at least 75 percent of a small employer’s eligible employees choose to be covered. Carriers should always “round up” when calculating the percentage. For example, a five-person company with only three employees willing to participate satisfies a requirement of 75 percent rounded up.
However, in the case of a business with only two eligible employees, the law requires 100 percent participation. A husband and wife who work in a business should be counted as two separate employees. Neither employee is eligible for coverage as a dependent of the other.
If you provide a health plan, state regulations and a federal law called COBRA (Consolidated Omnibus Budget Reconciliation Act) allow employees to keep benefits for a period of time after job separation. It is your legal responsibility to inform employees of their rights to continue coverage. Former employees who choose to continue their coverage through COBRA or state continuation must pay the full cost of the plan. You are not required to contribute to your premiums, even if you previously paid a portion. Ask your insurance company for details about their liability to former employees.
Types of plans offered
Health plans are classified as “state-mandated plans” or “consumer choice plans.” A state-mandated plan provides certain features and minimum required coverages. A consumer choice plan is any plan developed by a provider that excludes some state-mandated benefits. Generally, consumer choice plans that don’t include all state-mandated coverage will save you money on your monthly premium.
Although consumer choice plans are sometimes called “standard plans,” be careful not to interpret the term to mean that the coverages provided are “standardized.” Each provider’s consumer choice plan may be different, and a provider may offer several different consumer choice plans.
Some state-mandated benefits are still required for consumer choice plans, including coverages for:
* Treatment of phenylketonuria, if prescription drugs are covered.
* Pregnancy complications.
* Minimum hospital stay after labor (mandated by federal mandate).
* Reconstructive surgery after a mastectomy (federally mandated).
Consumer Choice Plans may vary depending on the type of provider offering the plan. For example, consumer choice HMO plans must pay for 20 outpatient mental health visits per member per year, but that is not a requirement in indemnity plans. Also, unlike insurance companies, consumer choice HMO plans must include basic health care services, such as preventive, inpatient, and outpatient services. Providers may offer optional benefits that vary widely from plan to plan.
You don’t have time for all this research and number crunching. But can you really afford to leave it on your “maybe someday” list? As the cost of health care rises, the risks of not having health insurance are more apparent than ever. Today, a single injury or illness, if uninsured, can leave a family in financial ruin. In addition, health coverage is a key benefit of employment. You may not be able to hire and keep the best employees without offering it.
Another alternative to group health insurance plans, which can be unaffordable for many small businesses, is to offer individual health insurance options to their employees. By law, an employer cannot contribute to these plans, or it would be treated as group insurance under Texas state law. But you can still help your employees stay insured under a good plan and improve their health and wellness, and also improve employee retention in the process. If you are a small business owner and would like to offer affordable health insurance plans to your employees, but cannot afford group health insurance, you should consider offering your employees the revolutionary and comprehensive individual health insurance solutions created by Previous specifically for young people. , healthy individuals.
Anterior offers affordable individual health plans with catastrophic coverage, but without a high deductible, and we will offer these plans to your employees at a discount. For more information, visit us on our website, [http://www.precedent.com]. We offer a unique and innovative suite of individual health insurance solutions, including highly competitive HSA-qualified plans and an unprecedented “real-time” application and acceptance experience.