Texas Health Insurance Benefits
Every small business in Dallas, Houston and throughout Texas wants to attract high quality individual employees who will contribute to the growth and success of the company. In order to recruit and retain these people, many larger business owners offer health insurance coverage, specifically group health, as an employee benefit.
If your company is small, especially if has ten or fewer employees, there are still ways to offer your employees health insurance coverage. In most states, insurance companies which offer small group health insurance plans are required to accept any employer group of two to 50 employees, provided the employer agrees to insure 100% of the eligible employees.
Before you can offer any health insurance coverage, you must decide how much your employees will pay, as well as the kind of insurance that you wish to offer.
It’s expensive. So who pays?
Most businesses that offer their employees group health insurance plans contribute towards the cost of the coverage. Some pay for all of the employees’ premiums (for single coverage) and let the employees pay the premium if they need coverage for their families. Other businesses pay a percentage of the total cost.
The amount you choose to pay will depend on your own situation. First, think about how your contribution will affect your budget. Second, think about how it affects the desirability of your plan to your present and future employees.
Many businesses choose to have their employees make a contribution towards some of the cost, especially as health care costs and insurance premiums continue to increase.
There are three major types of health plans – managed care, preferred provider, and fee-for-service. The plan that’s best for your business is determined largely by your business location, the physicians and hospitals available through the plan, the options offered by insurance companies, and the constraints of your budget.
Managed care plans are agreements between certain doctors, hospitals, and health care providers, and are designed to offer a range of services to members at a reduced cost. Managed care plans are typically HMOs. They may also be referred to as an Individual Practice Association (IPA) or Point of Service (POS) plan.
Most HMOs minimize the out-of-pocket expenses members pay for medical care, as long as members use the HMO’s preferred providers and facilities. If members go outside of the network, they may be responsible for paying the entire bill.
In addition, members must choose a primary care physician, and see that person first whenever they need medical attention. The primary care physician will make necessary referrals to specialists.
With HMOs, the per-visit or annual deductibles are usually lower than with other plans.
Preferred provider plans, known as PPOs, negotiate price discounts with health care providers. They refer to the health care providers that they have discounts with as “network” providers. PPOs pay a higher percentage of your employees’ claims if they use network providers.
Unlike HMOs members, PPOs members can see physicians without referral and can use physicians outside the network if they are willing to pay the non-network cost sharing.
PPOs generally require more cost sharing than HMOs, even for in network care. The per-visit or annual deductibles are usually higher than with HMO plans.
There may be some managed care elements with PPOs, but not as extensive as HMOs. For example, you may need pre-authorization for a hospital stay, surgery, or an expensive diagnostic test.
Fee for Service
Fee-for-service plans, also known as indemnity plans, allow employees to choose health care providers themselves. This gives them a wide range of options that includes specialists such as cardiologists and surgeons. But because these plans do not give members incentives to use low cost providers, the plans are expensive. Some insurance companies limit the fee-for-service expense by imposing low maximum benefits and/or fee schedules. As with any insurance plan, carefully read the benefit description for a fee-for-service plan.
Check out the insurance company
Along with selecting the right group health plan, selecting an insurance company is important, because the service delivered will directly impact each of your employees. Look for an insurance company with a good network of health care providers, timely claims service, and relatively stable premiums.
In addition, check with other small business owners in the area, or with your Small Business Association. The Texas Department of Insurance will also have information about the financial stability of the insurance companies that you are considering, as well as any history of customer complaints.
Can I choose my own small business health insurance provider?
Sure. Small business group health plans are available from reputable insurance companies who are using the Internet to help reduce administrative expenses.
Do I need an agent to help me select a plan?
No. Keep in mind that many agents only represent a small number of insurance companies. If you use an agent, you should expect him/her to ask questions about your goals and objectives and to learn about your business and employees before recommending a plan.
Health insurance for your employees can be expensive. The following tips will help you ensure you’re offering the best option for employees and the most cost-effective option for you.
Do your homework:
* Survey your employees for their insurance needs. Do their families require insurance?
* Consider insurance plans that require second opinions and include built-in cost containment features.
Talk to your employees:
* Design a plan that includes employee contributions towards cost and keeps employees informed of health care costs and rate changes.
* Create a committee to investigate the group health insurance market.
* Survey your employees to make sure you understand their needs and objectives before launching a plan.
Educate your employees about the cost of appropriate health care:
* Encourage employees to request second opinions and alternative, less invasive treatments.
* Help employees understand what is and is not covered under the plan.
Create a health-conscious work environment:
* Limit smoking at work to designated areas or eliminate it entirely.
* Offer healthy choices in vending machines and alternatives to pizza and beer at employee events.
* Promote moderation in use of alcohol and establish a zero tolerance drug and alcohol abuse policy.
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