Texas Group Health Insurance & Employee Benefit Plans

Texas Group Health Insurance & Employee Benefit Plans

As an independent group insurance agent, we are not limited by the available options of one particular carrier or health care plan type.

In other words, we have a wider net of group coverage options we can offer than if you partnered with a single provider, which would be limited to the plans and choices offered by that insurance company.

For more information about mandated health benefits that employers must offer as part of the Affordable Care Act, see this resource from the Texas Department of Insurance. You will find all non medicare related information here.

Call us today at the number at the top of the page to discuss our current group benefit options in Texas! We proudly serve the entire state and offer FREE estimates through our online request form to the right! No payment or obligation required!

Texas Large Group Health Insurance Plans

Eighty-three percent of workers in Texas are employed by a business that offers health insurance, and 76 percent have a choice of more than one plan. Of the employer-sponsored plans, 61 percent are self-funded, which exempts those employers from complying with Texas’ requirement for coverage that exceeds the ACA essential benefits provisions. In a self-funded plan, an employer forgoes using an insurer and sets aside money to pay for employees’ medical care, usually in a trust and administered by a third party. The approach is more common in large companies, which can spread risk through a wider employee population. The 39 percent that are fully insured (meaning that the company purchases coverage from an insurance provider rather than paying the medical costs directly) must cover these services in addition to the ACA benefits:

  • Brain Injury
  • Diabetes Care
  • Durable Medical Equipment (prosthetic/orthotic devices)
  • Off Label Prescription Drugs
  • Pediatric Services (reconstructive surgery for craniofacial abnormalities in children)
  • Prescription Drugs (oral anticancer medications)–
  • Reconstructive Surgery following mastectomy
  • Transplant Donor Coverage (for individual plans but not HMOs)

Although Texas’ large companies pay almost eighty percent of the single coverage premiums charged to their workers, the average employee still pays 8.7 percent of median income as their contribution.

Texas Small Business Health Insurance Plans

Small businesses (with fifty or fewer employees) are exempt from the mandate to offer health insurance to their workers. Still, health insurance is usually the top-requested benefit, and many companies want to provide it to their workforce. The ACA created SHOP (Small Business Health Options Program), which offers helpful resources for companies that want to provide healthcare insurance for their workers. Companies can learn about the options for coverage, pricing, and how to access information about tax credits. Taylor Benefits Insurance can help your company navigate the regulations and be sure that you locate the support that’s available for you. Small companies must meet these criteria to be eligible for the administrative support tax credit:

  • Employ fewer than 25 full-time equivalent employees (not including family members of owners or seasonal workers)
  • Pay average annual salaries of $50,000 or less per employee
  • Pay at least 50 percent of full-time employees’ premium costs
  • Purchase a qualified plan

Texas Employee Benefit Plans and Employee Benefit Packages

Texas is unique in not requiring private employers to carry workers’ compensation insurance to protect employees who may be injured on the job. In addition, Texas does not require paid or unpaid leave for illness or vacation.

However, many companies in Texas do provide a robust benefits package, with a third of workers enjoying dental care coverage, 21 percent with vision insurance, and half having access to an Employee Assistance Program. An EAP can be simple or complex. Typically, an EAP offers a fast, confidential response to the employee in crisis. The problems addressed include substance abuse, stress, family conflict, personal financial concerns, and more. Usually, the employee can initiate contact online or by phone to start the process and does not need to use their insurance to gain access to help. If the issue requires more than a brief support period, the EAP will refer the employee to more comprehensive assistance resources.

Texas Small Business Health Insurance & The Affordable Care Act

The Affordable Care Act, also sometimes referred to as Obamacare, has changed the way that group benefits are administrated and implemented. Understanding the challenges and opportunities made available by the new law is an important part of maximizing the value and cost efficiency of your business, which is where our experience comes in.

We’ve been working with small business owners to offer affordable, effective group benefits since well before the Affordable Care Act was put in place and we’ve played an essential role in helping our clients adjust to the new regulations during its implementation.

We pride ourselves on being able to come up with a creative solution that works for both your employees and your bottom line.

At Taylor Benefits, we are able to craft health plans that are specifically tailored to the needs and expectations of your company and its employees.

We do this by examining your current benefits offerings against the backdrop of other businesses in your industry, as well as the health coverage requirements dictated by current health care law and the precise goals of your business.

For a better understanding of what benefits are important to employees, see this informational guide for consumers from the Texas Department of State Health Services.

Need a small business health insurance plan for your Texas-based business? Call us today to learn how you can offer a cost-savings benefits package that will have a positive affect on the success and growth of your business!

Get started right away with a FREE health plan cost estimate or call us at the number at the top of the page to discuss your options!

Learn more about Texas employee benefit packages offered by Taylor Benefits.

Different Types of Texas Small Business Health Insurance Plans

The most important health insurance plans in individual or group health insurance industry are listed below. Have a look before choosing the most appropriate small business health insurance plan for your employees.

  • HMO Health Insurance Plans
  • PPO Health Insurance Plans
  • Indemnity Health Insurance Plans
  • HSA-Qualified Plan

Your needs and your employers spending capability decide the type of health plan you must opt for. We are providing you with a brief overview of the top four types of health insurance plans:

1) PPO Health Insurance Plans

Most commonly used insurance plan is PPO or “Preferred Provider Organization” health plan. To achieve highest claims, your doctor visits or hospital needs to be listed in the preferred providers list of insurer.

2) HMO Health Insurance Plans

Those insured by HMO plans should select a doctor to fulfill their health care needs and refer them to HMO specialist when needed. HMO is “Health Maintenance Organization.”

3) HSA-Qualified Health Insurance Plans

HSA-qualified plans are mainly used for Health Savings Accounts (HSAs). They are typically PPO plans with more flexibility.

It is a special bank account that lets you save money for medical expenses to be used in the future. Healthcare Reimbursement Plans (HRPs) can be used instead of HSAs as they have many advantages for employees.

4) Indemnity Health Insurance Plans

You can avail any hospital or doctors while using Indemnity plans. You have to pay some amount and later employees can apply for reimbursement. The insurer generally pays some part of total charges.

Texas Small Business Health Insurance Resources

You can check out Health Care Service Corporation that offer health insurance throughout the United States. Health Care Service Corporation is a mutual legal reserve company.

Texas Health Insurance Coverage has following resources:

  • Group Plans: It has a 6-month look-back period for pre-existing conditions of employees lacking prior coverage. Also, there is an exclusion period of 12 months from the open enrollment period. Well being benefits vary according to the chosen plan covering pre existing illnesses.
  • Individual Plans: Assorted plans depending on medical needs of members. They have a look-back period of 60 months and an exclusion period of 24 months to suit your medical needs. Health care costs limit exist on pre health conditions.
  • COBRA: Coverage period is 18-36 months. Benefits are according to previous employers. Insurance companies cover pre health conditions.
  • HIPAA: Benefits depends on selected program. No expiration period. Pre health conditions are covered.
  • HIPAA: Employer-sponsored health insurance scheme or Cobra plan. Full coverage of Pre existing health conditions.

Texas Health Insurance Eligibility

  • Group Plans: For Texas small businesses, covers an employee strength of 2-50 employees. Working period of eligible employees should be at least 30 hours a week. Owner must draw wages from the company and can be counted as an employee in Blue cross or Blue shield plan.
  • Individual Plans: If certain medical condition denies you health care coverage, then you can avail AHIP or PCIP and pay the premium.
  • COBRA: Guaranteed coverage for small business owners with 20 or greater than 20 employees. Employees sign-up till 60 days from the period of termination.
  • HIPAA: 18 months of continuous coverage is compulsory for all members. Cobra plan should be exhausted. Coverage should not lapse due to non-payment of employees premiums. 63 days are required to enroll for small employers and pay the premium.
  • HIPAA: Cobra plan or Employer-Sponsored Insurance should be accessible.

Texas Health Insurance Monthly Cost

  • Group Plans: Health care costs varies according to the employer contribution and members coverage.
  • Individual Plans: Rate caps don’t exist for individual health care coverage.
  • COBRA: Variation of cost between 102% to 150% of group rates.
  • HIPAA: Employees premiums are justified according to the plan you want to enroll for.
  • HIPAA: Employer-sponsored insurance premium is reimbursed monthly. It pays the insurance company for COBRA plan users.

Tax Credit in Texas for Health Insurance

Owning a small business with an average salary less than or equal to $50,000 a year and maximum 25 full-time employees you will certainly get a tax credit.*

This tax rebate comes under the Patient Protection and Affordable Care Act (PPACA). It helps small businesses to know distribution of the cost of group health insurance coverage.

Tax-exempt organizations can get a tax credit up to 35% of premium expenses. Premium paid for medical, vision and dental insurance of an employee can get a tax exemption of 50%.

*In some states, the tax credit is applicable only to Qualifying Health Plans (QHPs) available under government exchange. Restrictions apply on other providers with lower premiums.

Tax Credit Eligibility

Small businesses with 10 or less full-time employees getting a salary of $25,000 or less annually can get full credit. The credit amount gets reduced for companies with greater full-time workers and earning more.

All business eligibility rules depends upon number of full-time employees, so businesses running with part-time help are also eligible to enroll their members and pay the premium.

Looking to purchase group health insurance in Texas?

We provide insurance plans for individuals, dependents and any size small business available with the leading Texas health insurance companies at affordable premiums.

  • National General Benefits Solutions
  • UnitedHealthcare
  • Blue Cross and Blue Shield of Texas
  • Humana

Contact us today to get an instant quote for business group health plan costs.

Frequently Asked Questions About Health Insurance And Employee Benefit Plans in Texas

Here are some answers to common questions regarding Texas health insurance coverage.

Which Large Group Health Insurance Providers Are in Texas?

Taylor Benefits Insurance can connect you with some of the nation’s most reputable group health insurance providers. Years of dependable service have shown that you can always count on us to find you a great deal on large group coverage plans.

We collaborate with the insurance providers listed below:

  • Blue Cross
  • State Farm
  • Coventry Corp. Group
  • HIP Insurance Group
  • Carefirst Inc. Group
  • UHC of California
  • Metropolitan Group
  • HCSC Group
  • Blue Shield
  • eHealthInsurance
  • Humana Group
  • Kaiser Foundation Group
  • Unitedhealth Group

How Do Small Business Group Health Insurance Plans Work in Texas?

When it comes to Texas, small business health insurance can benefit small business owners in five ways.

The first one is a general-purpose group health insurance plan for small businesses. Employers pay a health coverage premium in order to provide health benefits to their employees and, in some cases, their employees’ families. However, the employee may pay a portion of this amount.

The Qualified Small Employer Health Reimbursement Arrangement (QSEHRA) is the second coverage to consider. Basically, employers (at their discretion) will provide employees with a fixed sum in benefits every month.

A Group Coverage Health Reimbursement plan is the third insurance coverage. This suggests that the firm would give group health insurance and also a monthly allowance to cover deductibles, copays, and other expenses.

Self-funded health insurance plans are a riskier choice for smaller enterprises. Employers cover their employees’ medical expenses and prescribed medications whenever they are presented rather than paying monthly premiums.

This last insurance coverage is known as Associate Health Plans (AHPs) and is also a risky financial option for small businesses. This is when several smaller enterprises within an industry or location band together to purchase a large group health plan from an insurance provider.

What Are the Different Types of Health Benefits Offered in Texas?

Taylor Benefits Insurance Agency provides the following benefits packages to businesses and employees in Texas:

  • health coverage
  • dental coverage
  • vision insurance
  • Disability insurance, both short and long term
  • 401k
  • retirement & pension
  • section 125 cafeteria
  • HSA
  • life insurance
  • long term care
  • ACA (Affordable Care Act)
  • Corporate health insurance & employee benefits
  • large groups

How Much Do Employers Pay for Health Insurance?

Employees can make any number of contributions to group health insurance programs. Employees’ monthly expenses start at $270, or $3240 per year. Employee contributions, by comparison, are more than three times less than that of the average American’s annual healthcare costs.

We’re ready to help! Call today: 800-903-6066