In most cases, yes. Network availability is based on the area in which you are seeking health insurance, but with group health policies in Texas, you can obtain a PPO, HMO, EPO, or a POS.
Frequently Asked Questions (FAQ)
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Explore our curated collection of FAQs. Click on a link below to view different categories.
Group Health Insurance
Am I able to get a PPO on an employer group health policy?
Are group health insurance policies compliant with the Affordable Care Act?
It depends. While you can obtain a plan that is not compliant, it’s generally not a good idea. Your employees will expect that they will have the protections of the Federal ACA law, and those will primarily include maternity coverage, coverage for all pre-existing condition and free preventative care, along with the 10 essential health benefits of the ACA.
Our business has 75 employees, some in States other than Texas. Can you help us?
Yes, we certainly can help, as a good portion of our Texas group health insurance clients have a presence in other States. While your company may be domiciled here, it’s very common to have staff in other areas of the U.S. Those employees will have access to additional plan designs but still be under the umbrella of your employer group health plan.
Can my employees visit any doctor they choose?
It depends on the type of health plan you offer. Most plans include a provider network, which is a group of doctors, hospitals, and clinics that have agreed to provide care at discounted rates. To get the highest level of coverage and lowest out-of-pocket costs, employees should visit providers within their plan’s network.
Can I form a group insurance plan anytime I like?
There is no “open enrollment” for group health insurance. You can form these plans anytime throughout the year and your renewal date will be 12 months after the effective date of the plan.
Our current broker keeps telling us to renew our company’s plan year after year. Should I shop around?
Yes. A lazy health insurance broker is a bad broker. We shop the market for every group health client each year at renewal, not just when you first sign on. Our commitment goes beyond the initial sale; we work hard year after year to ensure you and your employees always have access to the best benefits at the most competitive price.
My friend runs a company and uses a particular carrier. Should I just use what they have to make life easy?
Your organization may have different needs than that other company, and as such, you’ll want to custom-tailor your plan for your company and your employees. We do not place similar companies of a similar size using a one-size-fits-all approach. Each client we work with will have an employee benefits package that fits exactly what they need. There may be some overlap, but in general, no two companies are the same and have the same needs.
I’m looking for a group health, dental, vision, disability, and life insurance package for my company. Is that something you can handle?
This is a very common request, and we can easily stack these benefits to custom build exactly what you need. We use a consultative approach to find the best plan for your needs and then shop and negotiate with every credible carrier to deliver the best combination of employee benefits for your organization.
We currently use a PEO that bundles our benefits. It’s easy, but is this the best approach?
The short answer is no. When you use a PEO for payroll, health insurance, etc., you are assuming that they are experts in every area that you need to focus on. For example, a very large payroll company may be experts in payroll, but they are likely offering you a non-underwritten group health/dental/vision package that is priced quite a bit higher than what you should be paying for an underwritten package. By offering this to your employees, you are assuming a one size fits all approach is the best you can get for your business. Reach out to us and we’ll show you how truly flawed that approach really is.
I reached out to various group health insurance carriers directly, but this seems very complicated. Can you help me?
Yes! We’d love to help. Since there is no cost to using a solid broker, there is no downside. We have contracts with every reputable insurance carrier in the State and can even negotiate on your behalf to obtain the best possible outcome on rates and benefits. That’s something that would be nearly impossible to accomplish on your own.
How does Selected Benefits cater to Austin’s innovative business scene?
Austin is known for its startups and tech companies. We offer flexible and robust plans that cater to dynamic businesses, ensuring they can adapt as they grow.
Are There Options for Startup Health Insurance in Austin?
Yes, we provide startup health insurance in Austin that is customizable for new businesses, ensuring that your employees are covered while keeping costs manageable.
How can Austin businesses maximize their health insurance tax benefits?
Selected Benefits provides detailed guidance on tax benefits, ensuring eligible Austin businesses can make the most of available benefits.
With Austin’s diverse business sectors, how does Selected Benefits ensure relevant coverage?
Our team constantly researches Austin’s business trends. We ensure that our insurance offerings remain relevant and beneficial for all sectors in this dynamic city.
How does Selected Benefits cater to Dallas’s unique business environment?
Dallas is a blend of diverse industries. We offer a wide range of insurance plans to cater to each sector’s unique needs while ensuring compliance with regulations.
How can my Dallas business benefit from our expertise?
We won’t present to you or place your business with the same benefits solution as other businesses of your same size; we’ll tailor everything to fit your specific needs.
What about businesses that are on the cusp of requiring COBRA regulations in Dallas?
Businesses in Dallas with close to 20 employees should be prepared. We provide guidance on COBRA requirements and how to seamlessly implement them.
Are there any Dallas-centric health insurance considerations I should be aware of?
While many regulations are state-wide, Dallas businesses may have specific community health resources and partnerships. We’re here to connect you with those opportunities.
What is the Best Health Insurance for Small Businesses in Texas?
The best health insurance plan depends on your company’s size, budget, and employees’ needs. We can help you compare group health insurance options to find the best fit for your team.
What Are the Benefits of Group Health Insurance for Small Businesses?
Group health insurance helps small businesses reduce costs compared to individual plans while offering access to a wider range of coverage options. This coverage ensures employees have essential medical care and helps businesses of all sizes stay competitive by attracting top talent and retaining skilled team members.
How Do Regulations Affect My Health Insurance Options?
While ACA rules apply nationwide, Texas has its own participation and contribution challenges. Our expertise ensures your plan meets all state and federal requirements.
How does San Antonio’s rich history influence its business health insurance needs?
San Antonio’s blend of tradition and innovation means businesses here have diverse workforces. Our insurance plans are designed to cater to this variety, ensuring every team member is covered.
Are there special insurance plans for businesses in San Antonio’s tourism sector?
While the core features of our plans are consistent, we can tailor options for specific industries, like tourism, ensuring they meet unique needs.
How do I navigate the ACA mandates as a San Antonio business owner?
Our team is well-versed in both ACA and Texas regulations. We provide expert guidance, ensuring San Antonio businesses stay compliant while optimizing benefits.
Can Selected Benefits assist in connecting my business to San Antonio health resources?
Absolutely. We have partnerships with local health providers and can guide businesses to the best local health resources.
Individual/Family Health Insurance
What does deductible mean?
A deductible is the amount of money you have to pay before your health insurer (or auto insurer or homeowners insurer) begins providing you with coverage. For example, if you have a $500 deductible, you will not receive any payments from your health insurer until you’ve spent at least $500. Deductibles normally reset annually, so you’d have to spend $500 per year on qualifying medical expenses in this example. Typically, the higher the deductible, the lower the cost of insurance. Some insurers have no deductibles, while others have deductibles equal to several thousand dollars (these are normally called “high-deductible” health plans).
What does co-insurance mean?
Co-insurance refers to the percentage of medical costs that you are required to pay under the terms of your health insurance policy. When your policy has a coinsurance provision, it is normally expressed in terms of a ratio such as 80-20. In this example, the insurer would pay 80 percent of your covered healthcare costs, and you would pay the remaining 20 percent of your costs. The insurer begins paying their percentage of costs after you’ve already paid your deductible (if your policy has a deductible), and you will be responsible for yours up to the coinsurance limit, at which point your insurer becomes responsible for paying for 100 percent of the cost of care up to policy limits.
What is a lifetime limit?
A lifetime limit is the maximum amount of insurance coverage you have or the maximum that the health insurance company will pay out. After the passage of the Affordable Care Act, lifetime limits will no longer be applicable, and you will not be able to get cut off from medical coverage even if you incur very large expenses.
What is a pre-existing condition?
A pre-existing condition is a medical condition that you have before the time when you become covered by an insurance policy. For example, if you have diabetes but no insurance, when you later decide to buy insurance, your diabetes will be considered a pre-existing condition. Many insurance companies have limits on coverage for pre-existing conditions, although this too is changing as a result of the Affordable Care Act.
What is a premium?
Premium refers to the amount that you will pay for your health insurance coverage. Several factors affect your premium. One of the most important factors is whether you are insured as part of a group policy, such as policies offered by employers (these are the lowest cost policies), or whether you have an individual policy that you simply buy for yourself or your family. Other important factors in determining your premiums include your age, your current health status, any risk factors that make you more susceptible to serious illness, your deductible, your co-insurance agreement, and other considerations that affect the likelihood of the insurance company having to pay a large bill for medical expenses for you. You should not always assume that the insurance policy with the lowest premium is best. At Selected Benefits, we can help you evaluate all of the factors involved in choosing a Texas health insurance policy so you can get a policy that is the best value. Insurance premiums purchased through Selected Benefits are the same as premiums on policies placed directly through insurance companies.
Are there any PPOs in Texas for the self-employed?
We have several ways to insure you, including the ACA Marketplace plans, sometimes called “Obamacare”, but unfortunately, there are no PPOs on the Health Insurance Marketplace in Texas. In Texas, you’ll find both open and closed network HMOs, EPOs, and POS plans, just no PPOs. There are other options outside of the Marketplace, including short-term medical plans, “faith-based” plans, and indemnity plans, but none of these options are compliant with the Federal healthcare law. These will have limitations such as no or limited coverage for pre-existing conditions, maternity, and preventative care.
When the Marketplace asks for my income, what do they mean?
They are asking for an estimate of your adjusted gross income in the year in which you are seeking coverage.
If I earn more than my income estimate while on a Marketplace plan, do I have to pay the government back?
When you file your tax return for the year in which you were insured, the IRS will compare the income estimate with your actual adjusted gross income. If your actual income is higher than your estimate, you’ll pay back the IRS the difference in what subsidy you did receive vs. what subsidy you should have received. The same goes if you come in lower than your estimate; if you come in lower, the IRS will likely owe you money back, as you should have received a larger subsidy than you actually did. The point is the IRS will even it up to exactly what it should be; as they always do.
Can I see any doctor I want to?
Well you can if you want, but you generally just pay out of pocket if that physician is out of network on your plan. With any plan, you want to stay in the network of the policy that you have. A few individual health insurance plans may have out-of-network benefits, but most do not, and you will just pay whatever the doctor charges; there will not be a copay. You’ll be best off by just choosing your doctors, hospitals, and urgent care practitioners from the network directory of your chosen health policy.
Can I change Marketplace plans anytime I want to?
In a nutshell, no, you cannot. If you are outside of Marketplace open enrollment, you will need a Special Enrollment Provision, and those include making a permanent move to a new address, having or adopting a baby, recent release from jail or prison, a new marriage, gaining eligible immigration status or a loss of employer group health insurance coverage. Each of these will give you a 60-day window to be able to enroll in a family health insurance plan on the Marketplace.
My child is no longer eligible for Medicaid, now what?
If your child is either declined for or is no longer eligible for Medicaid, he/she has an automatic 60-day Special Enrollment Provision to enter the Health Insurance Marketplace and purchase a health insurance policy for your family.
My doctor says he accepts a certain insurance carrier, so why don’t I see that doctor in the provider directory for my plan?
For example, if your doctor says he accepts BCBS, you need to understand that BCBS has many, many different provider networks in every State. Some are linked only to employer group health plans, some are linked to Federal government employer plans, some are linked to health insurance policies for individuals through the Marketplace. The bottom line is to make sure that the doctor you want to see is in the network of the plan you have. A doctor’s office simply stating that “we take BCBS” is not good enough.
On a Marketplace plan, what’s the difference between a deductible and out of pocket?
You’ll pay 100% of the fees up to your deductible. After that, you have something called co-insurance, and that is when the insurance carrier pays 75% and you pay 25%, but not forever. Once you’ve reached your out-of-pocket limit, the insurance carrier will pay 100% thereafter for all in-network expenses. Remember, on ACA Marketplace plans, the deductible is always included in the out-of-pocket maximum. Out of pocket is generally the most you would be on the hook for in any calendar year.
I need surgery. If the hospital I choose is in my network, can I assume that all the doctors who work there are also in my network?
Definitely not. You want to check the provider directory and make sure any doctors, hospitals or even physical therapists are in the network of the plan you have. If your surgeon wants to use a hospital or facility that is out of your plan’s network, find another surgeon, or you’ll be in for a big surprise and not in a good way.
Why are some people I know able to get free health insurance on the Marketplace, but I pay much higher rates?
ACA Marketplace rates are based on several factors including a person’s age, size of the household, the household income estimate, etc. In very general terms, the lower your income, the less you’ll pay. For those with low income, you can even get better plan designs as the government will give you a “cost share reduction” which will artificially reduce your deductible and out of pocket on Silver plans for those with lower income levels.
Medicare Supplement
What is Medicare supplement insurance?
It’s a private health insurance policy specifically designed to pay expenses that are not covered by Parts A and B of Medicare.
At what point am I eligible for Medicare supplement insurance?
Once you are enrolled in both Medicare Parts A and B, you become eligible for a Medicare Supplement policy.
At what point can I apply for a Texas Medicare supplement policy?
Open enrollment is the best time to apply for a Medicare supplement plan in Texas. This includes a 6-month period beginning on the date you enroll in Part B of Medicare (if you’re at least age 65), or up to 6 months after your 65th birthday, contingent upon becoming eligible for Part B before you turn age 65. If you become eligible for Part B benefits before turning age 65 due to a disability or kidney failure, then you’re guaranteed to be eligible to enroll in the Texas Medicare Supplement policy of your choosing during that first 6 months once you are both age 65 and simultaneously enrolled in Medicare Part B.
Will my Medicare supplement policy include prescription drug coverage?
Actually, your Medicare supplement policy will not include RX coverage; however, you can choose to add the optional Medicare Part D Prescription Drug Plan for an additional cost.
Can I enroll in Part D if I do not have Parts A or B?
In order to be eligible for Medicare prescription drug coverage (Part D), you must be entitled to enroll in Part A and/or already enrolled in Part B.
Does everyone need a Medicare supplement policy in Texas?
Not everyone needs to purchase a Medicare supplement policy as they may already have the gaps in their Medicare plan covered through other means. You more than likely won’t need a Medigap policy if you:
- Are enrolled in a Medicare Advantage plan
- have Medicaid
- if the Qualified Medicare Beneficiary Program covers your annual Medicare premiums
- if you are still covered under a group health insurance plan through your current or former employer.
What happens if I stay employed after age 65 and continue to receive my employer group health insurance benefits?
You should be able to choose either your employer group health insurance plan or Medicare in addition to a Texas Medicare Supplement plan. If you decide to stay with the employer group health plan, you can use a Special Enrollment Period to delay the purchase of Part B until you’re ready.
Can I keep my doctor if I have a Medicare supplement plan?
As long as your doctor accepts Medicare assignment, which most do, you can keep your current physician(s). This also includes specialists, and as long as they accept Medicare assignment, your out-of-pocket costs will be less than if you use a specialist that doesn’t accept Medicare assignment.
Term Life Insurance
What is term life insurance?
Term life insurance is an insurance policy that will protect your loved ones if you die an untimely death. Term life insurance pays out a death benefit if you die while covered under the insurance. For example, if you have a 30-year term policy that offers $500,000 in coverage and you die within 30 years of the purchase date, the $500,000 death benefit will be paid out to your designated beneficiaries. At the end of the 30-year term, you will either have the opportunity to renew the policy, convert it to a whole-life policy, or let coverage lapse.
Why should I buy insurance coverage that doesn’t pay unless I die?
The purpose of buying term life insurance coverage is to protect your loved ones who may be depending on you financially. If you were to pass away unexpectedly at a young age, your spouse may be left unable to pay the mortgage and your kids might be left unsupported. Your other dependents, including aging parents, may also find themselves without the financial support they need. A term policy lets you protect your loved ones by ensuring that their financial status remains stable even if you pass away. Term life insurance can also be purchased to protect business partners. For example, if you are a partner in a business, a term life insurance policy can be purchased and can pay out to your partner to buy your half of the business in the event of your death.
When should I buy term life insurance?
The best time to buy term life insurance is when you are young as the policy premiums will be the lowest at this time since there is less risk of death. Even if you do not have people depending on your income now, if you expect to at some point in the future, then you should consider buying today.
Why should I buy term life insurance instead of whole life insurance?
Whole life insurance tends to be much more expensive than term life insurance. This is true not only because you pay more to insure yourself for life, but also because whole life insurance is a form of investment where you invest excess and earn a return. Most financial experts agree that there are better rates of return elsewhere and that term life insurance is a wiser choice. Not only that, but when you are older and the term of your insurance expires, hopefully, you’ll have enough money saved and have your mortgage and debts paid down so there will be no one dependent on you living and earning income.
Are there different types of term life insurance?
There are different types of term life insurance. Two of the major types include level term and yearly renewable term. Level-term insurance is often a better choice because your premiums and coverage remain the same for the life of the policy. Yearly renewable term may start out costing less, but the premiums can adjust upward each year, and your coverage can change annually, meaning the policy is likely to become much more expensive as you age.
How much life insurance do I need to buy?
The amount of life insurance you need is going to vary depending on your income and debts. An expert Texas insurance agent at Selected Benefits can help you determine exactly how much term life insurance you need to provide comprehensive protection for your family, business partners, and others you wish to protect through the purchase of your insurance policy.