| Finding the right group health plan for your business | | | | federal law called COBRA (Consolidated Omnibus |
| can be downright intimidating: sorting through lists of | | | | Budget Reconciliation Act) allow employees to maintain |
| insurance companies and plans; checking and | | | | benefits for a period of time after separation from the |
| re-checking the dollars and totals for deductibles and | | | | job. It is your legal responsibility to inform employees of |
| co-pays; making sense of plan limitations and | | | | their rights to continue coverage. Former employees |
| exclusions; deciphering a dictionary's worth of | | | | who choose to continue their coverage through |
| insurance-speak. It's enough to make anyone feel like a | | | | COBRA or state continuation must pay the full cost of |
| high-school freshman again. | | | | the plan. You are not obligated to contribute toward |
| Texas insurance law allows a wide array of health | | | | their premiums, even if you previously paid a share. |
| care coverage plans and packages. All group health | | | | Ask your carrier for details about your responsibility |
| insurance has its limitations and finding the right | | | | toward former employees. |
| employee health plan at the right price can be | | | | Types of Plans Offered |
| challenging. | | | | Health plans are classified as either "state-mandated |
| In Texas, the term "small employer" is a special | | | | plans" or "consumer choice plans." A state-mandated |
| insurance designation reserved for businesses with | | | | plan provides certain required minimum features and |
| two to 50 eligible employees. The law provides some | | | | coverages. A consumer choice plan is any plan |
| added protections to these businesses, including a 15 | | | | developed by a carrier that excludes some |
| percent annual cap on rate increases due to health | | | | state-mandated benefits. Generally, consumer choice |
| factors, a state-enforced guarantee that carriers | | | | plans that do not include all the state-mandated |
| cannot arbitrarily discontinue coverage, and a | | | | coverages will save you money on your monthly |
| cooperative purchasing provision that lets small | | | | premium. |
| employers pool their purchasing clout to negotiate | | | | Although consumer choice plans are sometimes called |
| lower rates. | | | | "standard plans," be careful not to interpret the term to |
| For employees of small businesses in Dallas, Houston | | | | mean that the coverages provided are "standardized." |
| and throughout Texas, the law provides several ways | | | | Each carrier's consumer choice plan may be different, |
| to maintain benefits after leaving a job and limits the | | | | and a carrier may offer several different consumer |
| waiting period before pre-existing conditions are | | | | choice plans. |
| covered. | | | | Some state-mandated benefits continue to be required |
| Beyond these requirements, small-employer carriers | | | | for consumer choice plans, including coverages for: |
| may offer a wide variety of plans, with virtually any | | | | * Phenylketonuria treatment, if prescription drugs are |
| combination of features and benefits. | | | | covered. |
| Small-Business Coverage Eligibility | | | | * Complications of pregnancy. |
| Texas businesses with two to 50 eligible employees | | | | * Minimum hospital stay after childbirth (federally |
| may obtain small-employer coverage from either a | | | | mandated). |
| traditional insurance company or a health maintenance | | | | * Reconstruction surgery following a mastectomy |
| organization (HMO). Eligible employees are defined as | | | | (federally mandated). |
| those who usually work at least 30 hours per week; | | | | Consumer choice plans may vary depending on the |
| are not classified as temporary, part-time, or seasonal; | | | | type of carrier offering the plan. For example, HMO |
| and are not already covered by another group health | | | | consumer choice plans must pay for 20 outpatient |
| plan. A business' owners count toward the employee | | | | mental health visits per enrollee per year, but that's not |
| total. | | | | a requirement in indemnity plans. In addition, unlike |
| The number of eligible employees -- not total | | | | insurance companies, HMO consumer choice plans |
| employees -- determines whether a business is | | | | must include basic health care services, such as |
| considered a small employer under Texas insurance | | | | inpatient, outpatient, and preventative services. Carriers |
| law. For example, if your business has 60 total | | | | may offer optional benefits that vary widely from plan |
| employees, it could still qualify if six of the workers are | | | | to plan. |
| part-time and four have coverage through some other | | | | You don't have the time for all this research and |
| source, such as a spouse's plan. | | | | number crunching. But can you really afford to leave it |
| If you decide to offer a group health plan to your | | | | on your "maybe someday" list? As the cost of medical |
| employees, you must make it equally available to all of | | | | care rises, the risks of not having health insurance are |
| your eligible employees and their dependents. | | | | more apparent than ever. Today a single injury or |
| Coverage is available under a small employer health | | | | illness --if uninsured-- can leave a family in financial ruin. |
| benefit plan if at least 75 percent of a small employer's | | | | Moreover, health coverage is a key benefit of |
| eligible employees elect to be covered. Carriers must | | | | employment. You may not be able to hire and keep |
| always "round up" when calculating the percentage. | | | | the best employees without offering it. |
| For example, a five-person business with only three | | | | Another alternative to group health insurance plans, |
| employees wanting to participate satisfies a 75 | | | | which can be unaffordable for many small businesses, |
| percent requirement by rounding up. | | | | is to offer individual health insurance options to your |
| However, in the case of a business with only two | | | | employees. By law, an employer is not allowed to |
| eligible employees, the law requires 100 percent | | | | contribute to these plans, or that would be treated as |
| participation. A husband and wife working in a business | | | | group insurance under Texas state law. But you can |
| must be counted as two separate employees. Neither | | | | still help your employees become insured in a good |
| of the employees is eligible for coverage as a | | | | plan and improve their health and well-being and also |
| dependent of the other. | | | | improve employee retention in the process. |
| If you provide a health plan, state regulations and a | | | | |