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Helpful Information
TEXAS GROUPS
For eligibility for group insurance products in Texas, clients must be headquartered in Texas and have a majority of employees in Texas.
CONTRIBUTION
Employers must be willing to contribute a minimum of 50% of the employee cost and have at least 75% participation of their eligible employees.
ELIGIBILITY
Eligible employee means an employee working at least 30 hours per week and has no other health coverage.
QUOTES
Insurance quotes are based on the information you provide. To obtain the most accurate quote, an employee census needs to be provided. Due to HIPPA privacy rules, it is not always possible to know about the medical conditions of your employees and their dependents. Quotes will be based on insurance carriers' base rates. Employee applications will be reviewed, and the final rate will be determined by the insurance carrier.
On small group insurance plans (2-50 employees), no one can be ridered or excluded for coverage. However, the insurance company can rate up your group to a maximum of 67% of the base rate for existing health conditions.
PRE-EXISTING CONDITIONS
Whenever you apply for new insurance coverage, you will be subject to a 12 month waiting period for pre-existing conditions. However, if you have a "Certificate of Creditable Coverage" from your prior insurance carrier that shows you had other coverage in the prior 12 months (with no more than a 63 day gap in coverage) you receive credit for the number of months you previously had coverage. All employees must have proof submitted, or they must meet the 12 months waiting period.
STATE CONTINUATION
The state of Texas has "State Continuation" which provides for continuation of the group plan for up to six months after an employee has terminated. The employee must have been on the group plan a minimum of 3 months to be eligible for State Continuation.
COBRA
COBRA rights are available to employees who terminate from a group who had 20 or more employees 50% of the time the prior calendar year. COBRA benefits are available for up to 18 months. The employer can charge 2% of the actual costs.
MEDICAL CONDITIONS THAT CAN AFFECT RATES:
(NOTE: Employers may not know this due to HIPPA privacy rules, but need to be aware that these medical conditions can affect premium rates.)
During the last 24 months, has any employee or dependent to be covered received treatment for asthma, alcohol or drug abuse, cancer, depression, diabetes, heart disease, high blood pressure, high cholesterol, kidney or liver ailments or any other major medical problem? Is anyone currently pregnant? Is anyone currently taking prescription medications? Has anyone incurred any claims in excess or $5,000 in last 12 months?
LINKS AND OTHER USEFUL SITES
The Texas Department of Insurance web page provides consumer information on policies and companies
Texas Health Insurance Risk Pool, for individuals who are ineligible for coverage elsewhere. NOTE: You are not eligible for Risk Pool if you are eligible for insurance coverage on a group plan or if you are eligible for COBRA benefits (you must exhaust the full 18 months). Also, there is a 12 month waiting period for pre-existing conditions unless you have prior creditable coverage.
The Department of Labor website - employee benefit regulations and lots of information!
CONEXIS - COBRA/HIPAA compliance administrator
Alt Benefit Consultants, Inc. - Cafeteria plan administration and FSA claims processing, Section 125 and Section 105 plans
The S'Cool - casual adult education. Look for my class on health insurance!
Individual Dental Quotes and online application to Dental Select
John Alden / Assurant Health Individual Medical or Short Term Medical Coverage
Unicare Individual Health Insurance
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