Group Health Insurance Plans are becoming more popular among small to medium-sized businesses. Understanding the regulations associated with the Group Health Insurance Plans can be very confusing and finding a reliable company familiar with all these regulations can be difficult. Integrity Insurance and Financial Services can assist you with all of the steps necessary to put together your Group Health Insurance Plan.
Integrity Insurance and Financial Services is proud to offer Small Business Group Health Insurance Plans through Blue Cross Blue Shield of Texas.
Reasons Why A Group Health Insurance Plan May Be Beneficial to your Company.
With a small Group Health Insurance Plan from Blue Cross Blue Shield of Texas, you have more network options including a larger PPO network in addition to HMO networks.
Build a plan that is as unique as your company.
At Integrity we know that your company is unique and your employees are unique. That is why we customize every Group Health Insurance Plan to specially fit both you and your employees needs and budget. Choose up to six different plans from a robust selection to offer your employees.
Create a Section 125 plan and your employee’s premium contributions may be made with pre-tax dollars (pre-tax contributions are only for employer-sponsored plans). This may reduce their taxable income. Some employees may get the most value from an employer-sponsored health plan (employees can save between 25-40% by purchasing plans through employer benefits).
Blue Directions from Blue Cross Blue Shield of Texas.
Blue Directions allows you to create a unique benefits program that meets the needs of your workforce and business.
Blue Directions gives you one secure website for handling all benefits management tasks. The administrator dashboard lets you:
- Manage employee eligibility
- Oversee all benefits plans like medical, dental and vision
- Track payroll deductions
- Get on-demand reporting at the click of a button
- Make staff updates
Blue Directions lets you create and offer a custom health care benefits package. You’ll choose from dozens of Blue Cross and Blue Shield of Texas (BCBSTX) plans with different:
- Copay/Coinsurance Levels
Employees can download BCBSTX’s suite of mobile apps to keep track of their health insurance plan details, appointments and stress levels:
- BCBSIL App – Access all of our mobile websites and services. Text BCBSTXAPP to 33633 to download*
- Centered App – Manage daily life stress and work towards becoming “centered.” Text CENTERED to 33633 to download*
- Health Family App – Get assistance managing your family’s preventive care. Text HF to 33633 to download*
*msg and data rates may apply
Reasons To Choose Integrity Insurance and Financial Services for your Group Health Insurance
- A dedicated team of Group Client Service Specialists to handle all of your needs.
- A team of licensed Agents who will come to your business to explain your company’s options.
- Integrity has been awarded Exclusive General Agency of the Year for the past three years for outstanding sales and service.
- Blue Directions, an online platform designed to help employees and employers access, update, and change different aspects of the Group Health Insurance Plan.
Common Questions Regarding Group Health Insurance Plans
What Is Group Coverage?
Group medical coverage refers to a single policy issued to a group (typically a business with employees, although there are other kinds of groups that can get coverage) that covers all eligible employees and sometimes their dependents. Individual medical coverage, on the other hand, is a single policy issued to a single person or family.
The rules are quite different for group coverage versus individual coverage, in large part because the insurer’s risk is calculated differently. With individual coverage, the insurer has historically based its premium rates (or denied coverage) on the detailed medical history of the person or family. (The Affordable Care Act will bring important changes to the individual market, including eliminating the ability of insurers to deny coverage based on preexisting conditions.)
With groups such as small businesses, the insurer determines a premium price based on risk factors balanced over the entire group, using general information on members of the group, such as age or gender. Insurers are required by law to offer coverage to small groups.
Is Insurance Required?
While there is no law requiring small business owners to provide health insurance, the Affordable Care Act makes substantial changes that small business owners should be aware of when deciding whether to purchase insurance for their employees. If you do choose to offer coverage, there are regulations you will have to follow—the most important of which we explain on this site.
Though large companies may face penalties in 2015 if they do not offer coverage under the Affordable Care Act, small businesses with fewer than 50 full-time-equivalent employees will not be penalized if they do not provide coverage. If you have at least 50 full-time-equivalent employees but none receive an individual premium tax credit or cost-sharing reductions (both based on income), there’s no penalty—whether or not you offer health insurance.
Is Your Business Eligible for Group Coverage?
Under federal law, small employers are guaranteed group coverage should they choose to purchase it, regardless of the employees’ health status. A “small employer” is defined as a business with 2 to 50 full-time employees. Owners are generally counted as employees, so sole proprietorships with one employee usually fall into this category, as do partnerships without any employees (by definition partnerships have two or more partners). Some states define the self-employed as “groups of one” and require insurers to guarantee issue them coverage in the small group market.
Who Is Eligible for Coverage?
The general rule is that if an employer offers group health coverage to any full-time employees, the employer must offer coverage to all full-time employees.
The employer has the option to offer coverage to part-time employees (defined as those working fewer than 30 hours per week). If the employer offers coverage to any part-time employees, all of them must be offered coverage.
These rules apply regardless of the medical condition of the employees. In other words, any eligible employee can’t be denied coverage based on previous medical problems, known as preexisting conditions.
Under the Affordable Care Act, group insurance plans are required to extend coverage to adult dependents through age 26. This only applies in cases where the adult dependent’s employer does not offer coverage. In 2014, the provision applies to all people under 26, whether or not their employer offers coverage. Dependents cannot enroll for coverage unless the employee has enrolled
What Employees Are Eligible?
An employer can cover any employee who is on the payroll and for whom he or she pays payroll taxes. Although employees can opt out of the benefit program, virtually all insurers do require that a minimum number of your employees participate in their plan. Eligible employees generally include those who are on paid vacation, maternity or sick leave. With few exceptions, employees who are on unpaid leave are ineligible until they return to active work.
The following individuals are usually not eligible for small group medical coverage:
- Employees covered under a collective bargaining agreement
- Employees of unrelated organizations
- Independent contractors
- Non-employee directors of the company
- Seasonal employees
- Temporary employees
What if I Have Fewer than 25 Employees?
Businesses with fewer than 50 full time equivalent employees are exempt from penalties; however, you may qualify for employer health care tax credits.
What if I have Fewer than 50 Employees?
Businesses with fewer than 50 full time equivalent employees are exempt from penalties (also known as the Employer Shared Responsibility Payment or “Play or Pay” penalty) faced by larger employers that do not offer coverage. However, employers who are close to reaching 50 full time equivalents are encouraged to closely monitor their workforce, as reaching the threshold and not offering health care coverage can result in steep penalties.
What if my business has 50 or more employees?
Many important parts of the health care law apply to businesses with more than 50 full time equivalent employees. Under the health care law, employers with 50 or more full time equivalents are considered “large businesses” and therefore required to offer employee health care coverage, or pay a penalty. Large employers will also be required to comply with a second mandate, which is to report to the IRS on the employee health coverage offered or not offered. Initial reports will be due by January 31, 2016, for the 2015 tax year.
For more information or to have a Small Group Health Insurance Specialist call you please feel free to fill out the form below.