At Selected Benefits, we specialize in both Large and Small Group Health Insurance for Texas businesses.
Our health insurance carriers include, but are not limited to Aetna, Blue Cross, Cigna, Humana, United Healthcare, National General, Allied, Memorial Hermann and many others. We will shop you through traditional plans, underwritten plans and self-insured plans. We do this because our goal is to deliver what you need at the absolute lowest price without sacrificing quality. On average, companies that switch to us save $1,000 or more per employee and see their benefit costs kept down as low as possible year after year.
We’ll be happy to help educate small business owners in Texas about how group medical insurance plans can provide their employees and families the coverage that they really value.
We use ACA plans for some of our groups that have challenging health conditions, but for employer groups that are healthier than normal, we like to shop you with underwritten and self-insured plans as we can often save your business between 15 and 30% over the best ACA related group premiums. Most insurance agencies don’t shop those carriers because they require more work and understanding on the front and back end to support. We specialize in this because it is an incredible tool to save you money. Case in point, we just recently saved a 21 person group over $60,000 per year using this approach. We use the same approach when searching for ancillary benefits such as group dental, group vision, long term disability and group life insurance.
Businesses with less than 50 full time “equivalent” employees are exempt from paying a penalty for not providing ACA compliant health insurance coverage to its’ employees, of course, the employer can still provide health insurance coverage at its discretion. Any applicable large employer will be mandated to offer minimum essential coverage that is affordable to their employees. An applicable large employer is a business that has over 50 employees in a single business or an owner that owns multiple business that total over 50 employees. Those large employers who fail to meet these requirements will be required to pay an IRS “penalty” on their tax return for the year in which they did not meet said requirement.
A full time employee, as defined by the Federal law, is one who works a minimum of 30 hours per week and the law considers every 120 hours worked by a part time employee, during a month, as equal to one full time employee. Per Federal law, an employer must give new hire a minimum of 31 days from the day their employment begins to enroll in a Texas health insurance plan. Once this time passes, an employee could possibly be required to wait as much as one year to join the employer’s group health insurance plan during the next open enrollment period for that particular plan. By law, an insurance carrier must offer an open enrollment period once per year for each group health insurance policy.
An employer, at its discretion, may require its employees to wait for up to 90 days after they enroll in a health plan for their insurance coverage to begin and the insurance carrier is prohibited from charging a premium for the health insurance policy during this period.
Referred to as COBRA or continuation of coverage, employees generally have the option to keep their existing policy for a length of time after leaving their old job. The old employer must inform its employees about their continuation of coverage rights. This can be a very expensive option for the employee as they must pay the full premium of the plan without any contribution from the former employer. It is not mandated that employers pay premiums for former employees even if they previously paid a portion.
While current law does not require the employer to pay all or part of an employee’s health insurance premiums, the insurance companies generally require the employer to pay a minimum of 50% of the annual premium of the employee, though an employer, at its discretion, can choose to pay a larger percentage of the premium.
Always a bone of contention, an insurance carrier may increase the insurance policy premium due to both general increases in the cost of healthcare or as a result of the aging of the members of the small group health insurance policy. On ACA related policies, the insurance carrier is prohibited from a premium raise simply due to adverse health issues of the individual insureds of the group. In addition, if the insurance company decides to discontinue that policy at the end of the policy year, it must, by law, offer a replacement policy to the employer.
An insurance carrier will base the premium amount employers pay for the insurance coverage on both the benefits and the cost sharing that the employer chooses to offer his employees. Because of the ACA, the health condition of an insured no longer is a consideration when determining the premium rate. The three main factors that a Texas health insurance carrier will use to determine the rates are 1) Age of the Employees, 2) Tobacco use and 3) the geographic area of the insureds and while this is true with ACA policies, those are just one of the tools in our bucket.