Finding the right group health plan for your business can be downright intimidating: sorting through lists of insurance companies and plans; checking and re-checking the dollars and totals for deductibles and co-pays; making sense of plan limitations and exclusions; deciphering a dictionary’s worth of insurance-speak. It’s enough to make anyone feel like a high-school freshman again.
Texas insurance law allows a wide array of health care coverage plans and packages. All group health insurance has its limitations and finding the right employee health plan at the right price can be challenging.
In Texas, the term “small employer” is a special insurance designation reserved for businesses with two to 50 eligible employees. The law provides some added protections to these businesses, including a 15 percent annual cap on rate increases due to health factors, a state-enforced guarantee that carriers cannot arbitrarily discontinue coverage, and a cooperative purchasing provision that lets small employers pool their purchasing clout to negotiate lower rates.
For employees of small businesses in Dallas, Houston and throughout Texas, the law provides several ways to maintain benefits after leaving a job and limits the waiting period before pre-existing conditions are covered.
Beyond these requirements, small-employer carriers may offer a wide variety of plans, with virtually any combination of features and benefits.
Small-Business Coverage Eligibility
Texas businesses with two to 50 eligible employees may obtain small-employer coverage from either a traditional insurance company or a health maintenance organization (HMO). Eligible employees are defined as those who usually work at least 30 hours per week; are not classified as temporary, part-time, or seasonal; and are not already covered by another group health plan. A business’ owners count toward the employee total.
The number of eligible employees — not total employees — determines whether a business is considered a small employer under Texas insurance law. For example, if your business has 60 total employees, it could still qualify if six of the workers are part-time and four have coverage through some other source, such as a spouse’s plan.
If you decide to offer a group health plan to your employees, you must make it equally available to all of your eligible employees and their dependents.
Coverage is available under a small employer health benefit plan if at least 75 percent of a small employer’s eligible employees elect to be covered. Carriers must always “round up” when calculating the percentage. For example, a five-person business with only three employees wanting to participate satisfies a 75 percent requirement by rounding up.
However, in the case of a business with only two eligible employees, the law requires 100 percent participation. A husband and wife working in a business must be counted as two separate employees. Neither of the employees is eligible for coverage as a dependent of the other.
If you provide a health plan, state regulations and a federal law called COBRA (Consolidated Omnibus Budget Reconciliation Act) allow employees to maintain benefits for a period of time after separation from the job. It is your legal responsibility to inform employees of their rights to continue coverage. Former employees who choose to continue their coverage through COBRA or state continuation must pay the full cost of the plan. You are not obligated to contribute toward their premiums, even if you previously paid a share. Ask your carrier for details about your responsibility toward former employees.
Types of Plans Offered
Health plans are classified as either “state-mandated plans” or “consumer choice plans.” A state-mandated plan provides certain required minimum features and coverages. A consumer choice plan is any plan developed by a carrier that excludes some state-mandated benefits. Generally, consumer choice plans that do not include all the state-mandated coverages will save you money on your monthly premium.
Although consumer choice plans are sometimes called “standard plans,” be careful not to interpret the term to mean that the coverages provided are “standardized.” Each carrier’s consumer choice plan may be different, and a carrier may offer several different consumer choice plans.
Some state-mandated benefits continue to be required for consumer choice plans, including coverages for:
* Phenylketonuria treatment, if prescription drugs are covered.
* Complications of pregnancy.
* Minimum hospital stay after childbirth (federally mandated).
* Reconstruction surgery following a mastectomy (federally mandated).
Consumer choice plans may vary depending on the type of carrier offering the plan. For example, HMO consumer choice plans must pay for 20 outpatient mental health visits per enrollee per year, but that’s not a requirement in indemnity plans. In addition, unlike insurance companies, HMO consumer choice plans must include basic health care services, such as inpatient, outpatient, and preventative services. Carriers may offer optional benefits that vary widely from plan to plan.
You don’t have the time for all this research and number crunching. But can you really afford to leave it on your “maybe someday” list? As the cost of medical care rises, the risks of not having health insurance are more apparent than ever. Today a single injury or illness –if uninsured– can leave a family in financial ruin. Moreover, health coverage is a key benefit of employment. You may not be able to hire and keep the best employees without offering it.
Another alternative to group health insurance plans, which can be unaffordable for many small businesses, is to offer individual health insurance options to your employees. By law, an employer is not allowed to contribute to these plans, or that would be treated as group insurance under Texas state law. But you can still help your employees become insured in a good plan and improve their health and well-being and also improve employee retention in the process.
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- More Small Business Health Insurance Basics In Texas
- Health Insurance Basic Plans
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When considering the family budget and being a good parent, providing quality healthcare at a reasonable price is right up there with the mortgage payment, car payments and college tuition. Consumer driven healthcare is a movement in the United States. Consumer Driven Healthcare relies on a free-market approach to control costs through consumer choice, with employees assuming greater ownership for their healthcare decisions and related finances. Consumer driven healthcare is about changing employee behavior. Consumer driven healthcare is just talk and will fail unless we want to walk the walk. In simple words, the hope for consumer driven healthcare comes from the simple notion that putting responsibility for expenses and decisions back into the hands of the consumer will result in more rational utilization of resources. So while the healthcare debate heats up in Washington, across the state capitals, in corporate boardrooms, on the campaign trail and on TV, some of us folks are trying to make sense of “consumer driven healthcare”.
Consumer-Driven Healthcare also referred to as “CDH”, is a type of health plan that gives members more choice and flexibility in making health benefits decisions and more control over their health benefits dollars. Consumer-driven care will change the way your hospital does business. Consumers will increasingly take on the responsibility of managing their own health benefits, in many cases through individually held health savings accounts that will give them greater freedom to determine when and how they spend their healthcare dollars. Consumer-driven healthcare is defined as a system where consumers, not the employer or insurance provider, determine how and where to spend their healthcare dollars. However, consumer-driven healthcare (CDH) can result in savings and greater flexibility for consumers of all kinds. The merits of various types of consumer-driven programs are being hotly debated, but the reality is that CDHC simultaneously creates both a consumer “movement” as their financial responsibility and involvement in their care choices increase, and a consumer experience.
If healthcare were consumer-driven, “maintenance” prescriptions (medications you need over long periods of time) wouldn’t require complicated pre-authorization forms from your doctor, which are usually rejected the first time around. If healthcare were consumer-driven, basic allergy medications like Zyrtec wouldn’t be so hard to come by, and wouldn’t cost $25 a bottle out-of-pocket. If healthcare were consumer-driven, patients wouldn’t be forced to choose between complex HMO, PPO, and POS plan options that leave a loophole for various “medical groups” to decline responsibility for specific doctor’s office visits or treatments (sticking the befuddled patient with the full bill). “Consumers have choice in every area of their lives, except healthcare,” he stated. Nearly 85 percent of consumers responding to a new survey said that they believed hospitals and doctors should be required to disclose their prices.
Opponents argue that CDH is really just cost shifting from employers to employees and that rather than spending more responsibly, consumers in these types of plans will be more inclined to avoid necessary care.
Consider these options for maximizing your health care discounts: Ask your doctor’s office if they provide a discount for paying cash. Start today and put these easy steps into practice to become a champion of consumerism and proactive consumer of health care. A survey of more than 70 leading health care insurers (representing more than 100 million insured individuals) found that over the next 12 months health care costs are projected to increase by 10. However, consumer-driven healthcare (CDH) can result in savings and greater flexibility for consumers of all kinds. Learn how CDHC will change the way health care is financed and delivered. Understand how CDHC will affect health plans, healthcare providers and pharmaceutical companies.
Shop-Till-You-Drop the debate rages on about how to reform healthcare in America… Meanwhile, what can we do to become more successful consumers? We consumers may not be in the healthcare driver’s seat yet, but we can at least become more vocal back-seat drivers. ” The consumer experience combines the individual’s sense of empowerment, because he has direct input into decisions about his healthcare, with the knowledge and tools he needs to make those decisions.
In my opinion the ultimate goal of CDHC should be to put control of you health decisions back into the hands of the consumer and their healthcare provider of choice, (in other words you and your doctor) not into the hands of the insurance companies and the employer. To get the biggest bang from your buck look at getting a
1. Discount Health Plan,
2. Health Savings Account
3. High Deductible Health Plan
The Discount Health Plan saves you money on the day to day health care expenses. The Health Savings Plan is a savings account where you deposit money for future large medical or other expenses. The High Deductible Insurance Plan will kick in to cover the hospital expenses when something really serious happens such as heart attack, stroke, cancer etc. But and this is a big but, YOU ARE RESPONSIBLE FOR PAYING THE DEDUCTIBLE and that could be up to $5 or $10 thousand dollars or more depending on your plan. This is why you will need the discount plan and the savings plan. If your cash flow is low and you have a really good Discount Health Plan which includes a Patient Advocacy program at no additional cost this is a good start. The Patient Advocacy program will negotiate with the hospital and GREATLY reduce or eliminate your hospital bill when you have one. You can find a really excellent plan for less then $60 a month for an entire household. When you can afford to add the other one or two do so if you desire. You may want to read my other article Healthcare and the Family Budget – What is a Health Savings Account and Do You Need It?
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- Healthcare and the Family Budget – What is a Health Savings Account and Do you Need It?
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It’s not unusual to use a recession to make a major career change. While others are floundering, you can be advancing your career by going to school or pursing an entirely new path. These days, the healthcare industry is very popular – and with good reason! Healthcare is only of the only places that has added jobs in the last 2 months. Healthcare workers are also unable to be outsourced and will always been in demand as long as people are catching colds, breaking bones, and having babies.
There are countless reasons why a healthcare career might be right for you. Here are just a few:
1. Healthcare professionals are in demand.
Unlike almost every other industry today, healthcare is actually hiring! Over 50,000 jobs were added in January 2009, plus 29,000 more in February. Some of the most popular occupations were registered nurses, medical assistants, and primary care physicians.
2. There are tons of options.
No matter what sort of education or experience you have, you can apply yourself to a healthcare career. The thought of blood make you squeamish? Careers in healthcare administration or medical coding/billing involve little to no interaction with patients. Love interacting with people? Nurses and medical assistants are often the first people to see a patient when they come into a hospital or clinic. You’ll get tons of exposure to a large variety of patients. Because there are so many healthcare jobs, you’re bound to find one that suits your interests.
3. You don’t need an advanced degree.
Despite what you may think, most healthcare careers don’t require an advanced degree. Physicians actually make up only a small portion of healthcare professionals. There are dozens of careers that ask for just an associate’s or bachelor’s degree. Don’t let a perceived lack of education keep you from working in healthcare.
4. Room to advance.
Many healthcare jobs offer tons of room for advancement as well as chances to take on leadership roles. What’s more, many skills are transferable from one career to the next. Tired of your job as a medical assistant? Got back to school for your Bachelor of Science in Nursing to become a Registered Nurse! You’ll already have great experience and there’s a chance that many of your classes will feel like review.
5. You can expect job stability.
Unlike a need for big screen TVs and fancy cars, healthcare is always in demand no matter where the economy takes us. People will always get sick. Women will always give birth. Medical bills will always need processing. Because of this, healthcare workers can expect to have relatively stable careers. Of course, every region and facility is different, but even with downturns, healthcare professionals can expect to see their jobs remain necessary. What’s more, healthcare workers can’t be out-sourced. It would be impossible to treat or diagnose a patient from thousands of miles away.
6. It’s rewarding.
How do you feel after volunteering at your local homeless shelter, or participating in a mentor program? You feel great, right? How would you like to feel like that on a daily basis? Healthcare workers get to make a difference every day. You don’t have to be a trauma physician to change someone’s life. The nurse who takes an extra ten minutes to get to know her patients, or the rad tech who comforts a nervous patient can have an even greater impact than a surgeon.
7. It’s exciting.
You’re changing lives on a daily basis! How can that not be exciting? Many healthcare workers get to build their careers on excitement and adrenaline. This can be a fast-paced, challenging job where you get to do something different every day. Why sit at a desk when you can be taking vitals, deciphering x-rays, drawing blood, and so much more?
Ready to get started with your healthcare career? Check out AllHealthcare.com for career advice, networking opportunities, and quizzes to help you determine which healthcare career is right for you.
Related posts:
- How can we make jobs in healthcare more palatable for workers?
- The Forcast for Healthcare Management Jobs
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Shopping for affordable health insurance can certainly be an eye-opener. If you have always had a health insurance benefit where you work - especially a state or federal employee - and now have to buy your own, you may not be able to afford the level of health insurance coverage you have become used to
Affordable health insurance - it seems, especially today, those words just don’t belong together in the same sentence. Health insurance monthly premiums have become the biggest single expense in our lives - surpassing even mortgage payments. In fact, if you have any permanent health problems, such as diabetes, or have had cancer at one time in your family history, your monthly cost could easily be more than the house and car payment combined. .
Affordable health insurance, however, is definitely available -if you know how and where to look.
When you are looking for affordable health insurance, you want the lowest cost per year that will fit your budget, of course. But, even more importantly, you want a company that has a good record for paying without fighting with you on every detail. Just as there is a car for just about any budget, there is also affordable health insurance. You may not be able to afford a “Cadillac” policy - but then you probably don’t need all the frills anyway.
Shopping for health insurance on the internet is the easiest and best way to find affordable health insurance. Here are five reasons why.
1. You don’t need a local agent to help you submit the claims for health insurance. The medical provider does it for you. You save money because the health insurance company saves money by not paying the agent commission. This could amount to an 8% to 12% savings to you.
2. All the top health insurance companies are at your fingertips on the internet. Most local agents can only quote you from the few companies that they represent. They may not offer you what is best for you financially or health-wise but only what they happen to have available.
3. Health insurance companies have to be extremely competitive because it is so quick and easy to compare them with their competitors on the internet today. In the past you would have had to visit physically eight to ten agents to do a similar comparison. Most folks just didn’t have the time or desire for that.
4. You can change your coverage, deductibles, and payment options with just a few clicks rather than going through the paperwork delay with a local agent (and then finding out he/she made a mistake - more delay).
5. Charging to a credit card means you aren’t going to forget a payment and be without insurance. Also, it gives you another 30 days before you actually have to pay. Also, many companies today give an additional discount for “auto-pay”.
The key, however, to finding affordable health insurance is realizing that the purpose of any health insurance is to protect you from a major financial loss - not to protect you from spending small money on clinic visits and sliver removal. These small expenses may be cumbersome but they generally will not hurt you. It’s the $100,000 heart operation that will break you. That’s the financial disaster health insurance was originally designed to prevent.
Also, keep this in mind. Health insurance, as with any insurance, is a gamble. You are gambling that you will draw out more than you pay in. Your health insurance company is gambling they will pay out less. The odds are in their favor for two reasons. They have all the facts for millions of families to average out, so they know the risk in advance. Also, they get to set the rules and the prices. The higher you set your deductible, the more risk you take. This is not a bad thing at all. You will most likely be the winner in the long run.
Yes, finding affordable health insurance is much easier than most people think.
Taking more of the risk with higher deductibles, spending a little time on the internet comparing eight to ten different companies, and deleting coverage that you will not likely need (such as maternity for many folks) will make it very possible to find your own affordable health insurance.
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Taken from the Mix08 presentation by Daniel Makowski (sessions.visitmix.com
No related posts.
Family Health Insurance rates are constantly on the rise in the US, but one thing is for certain, if you are healthy, your group policy is more expensive then if you had a Family Health Insurance plan. This is especially true in Nevada, Florida, Ohio, Connecticut, and Georgia.
Right now in the US it is very popular for employers to contribute money toward the employee’s premium but not toward the spouse or children’s premium. If you are a healthy family and you are in this situation it is important for you to speak with a health insurance agent as soon as possible.
A prime example of this is when my sister in Ohio, started a new job, her family health insurance offered through the employer was almost $800 a month. They contributed about $300 a month and she was left with paying $500 a month to insure her husband and two children.
We ran her a quote through Ohio Health Insurance Quote (who currently offers free health insurance quotes in Ohio, Florida, Nevada, Georgia and Connecticut) and she was able to get an Ohio Health Insurance policy for her family for $355 a month. Furthermore, she approached her employer and the employer agreed to still contribute $250 a month toward her insurance if she agreed to provide her own insurance. Now her family only contributes $105 a month and they have their own policy. This means if she decides to work for another company she can take her health insurance with her, or when she retires she can keep this plan and not worry about being insurable when she is 55 or 60 years old.
Also If you are a student and live in Nevada, Florida, Ohio, Connecticut, and Georgia. You may want to decline the health insurance being offered through your college or university and get an individual policy offered by UnitedHealthcare, Aetna, Humana, or Anthem Blue Cross Blue Shield. An individual policy is much preferred because the health insurance is not associated with ones education. Should a student become ill and have to drop out of college, he or she does not have to worry about losing his or her medical insurance.
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It should totally cover third-leg attachments and heightening surgery. Note: this video is not made to support socialism, though some of the passersby might suggest it as a solution. K?
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My friend was in an auto accident, and the health insurance from the auto insurer is her primary health insurance for the accident. She also has regular health insurance from another company. If the auto insurer pays 80% of her auto accident medical costs, and her secondary insurance normally pays 70% of her medical costs, then how would the secondary insurance treat a $1000 bill, for example? The auto insurer pays $800 of the $1000 bill (80%), but how much would the secondary health insurer pay?
SRC50
Auto insurance covers medical costs from an accident when auto insurance is selected as the primary health insurance for an accident. She therefore has two health insurance coverages in terms of her auto injuries only.
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