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Small Group Health Insurance

For employees of small businesses, the law provides several ways to maintain benefits after leaving a job and limits the waiting period before a health plan will cover pre-existing conditions. Beyond these requirements, small-employer carriers may offer a wide variety of plans, with virtually any combination of features and benefits.


Group health plans
Group plans are commonly offered by employers as part of an employee benefits package. Most Texans with health coverage are in employer-sponsored group plans, through either their own employer or their spouse’s employer. The state and federal laws for group plans are somewhat different depending on the size and nature of the group. Texas law contains special provisions for plans offered by small businesses. For instance, some state-mandated benefits that must be included in plans offered by large employers do not have to be included in small-employer plans.

Employers and groups aren’t required to offer health coverage to their employees and members. Those that do are not required to contribute toward plan premiums. Some carriers, however, may require employers to pay 50 percent or more of an employee’s premiums.

Small-employer plans are plans sponsored by businesses with between two and 50 eligible employees. Eligible employees must be full-time employees who usually work at least 30 hours a week. In addition, they may not have health coverage through some other source and must not be seasonal, part-time, or substitute workers. If a small employer offers a plan, it must be made available to all eligible employees equally.

Texas Small Employer Health Insurance
Small employers can choose whether to offer health insurance to their employees. If they offer health insurance, it must be available to all employees working 30 hours or more per week and their dependents.

Texas insurance law defines a small employer as a business with two to 50 employees, regardless of how many hours they work. In general, insurance companies require at least 75 percent of a small employer's full-time employees to participate in the health plan.

Insurance companies that sell small-employer coverage must make it available year-round. However, if an employer doesn’t meet the 75 percent participation requirement, an insurance company can make the employer wait until the open enrollment period to buy coverage. The open enrollment period is from November 1 through January 31 of each year. Source: TDI - read more

Helping You Help Your Employees with Medicare Enrollment

Do you have employees or retirees who are eligible to enroll in Medicare? Many people are still working when they’re first eligible for Medicare, and they need to decide if they should get Medicare Part B coverage.

Those newly eligible for Medicare who are still working or have employer coverage have important decisions to make. It’s important they understand how and when to enroll, as well as the consequences of not enrolling. Those who don’t enroll timely may have gaps in their insurance coverage and may pay more for Part B (late enrollment penalty) for as long as they have that coverage. There’s other important information to understand about Medicare enrollment, for example:

  • Some people get Medicare automatically, and some need to sign up for it. 
  • People can enroll in Medicare Part B only at certain times.
  • There are special enrollment rules for those who are still working and covered by an employer.
  • Not everyone with Medicare is 65 or older.

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