To qualify for group coverage as a small business, your company needs between two and 50 full-time employees (including the owner). All full-time employees of an employer are eligible for insurance under a group policy. And 75% of eligible employees must select health plan coverage.
An individual is considered a full-time employee if they work a minimum of 30 hours a week on a regular basis. The term also includes a sole proprietor, a partner, and an independent contractor, if the sole proprietor, partner, or independent contractor is included as an employee under a health benefit plan of a small or large employer, regardless of the number of hours the sole proprietor, partner, or independent contractor works weekly, but only if the plan includes at least two other eligible employees who work on a full-time basis and who usually work at least 30 hours a week.
For guidance on other qualifiers, call 833-923-1785.
If you purchase insurance between November 1 and December 15 for a January 1 or January 15 effective date, this participation requirement is waived.
Employers must provide TWC (Texas Workforce Commission) quarterly wage and tax statement for all employees, and indicate full time, part time, seasonal, temporary, or terminated status for each employee on the document.
If your company is a new business, you may not have this document. This will require a Supplemental Employment Verification form, state filed proof of business, and W-4’s for allW-2 employees.
Partnerships with no other employees require TWC and state filed proof of business. If they do not claim wages, K-1 documents for all partners of the group are required. If they are listed as stockholders, they do not qualify for coverage.
In Texas, independent contractors may be eligible if they are included as an employee under a health benefit plan of a small or large employer, regardless of the number of hours they work weekly but only if the plan includes at least two other eligible employees who work on a full-time basis and who usually work at least 30 hours a week. These individuals are considered eligible if they work full time exclusively for the employer.
Eligible employee regulation includes a sole proprietor and a partner, if the sole proprietor and partner is included as an employee under a health benefit plan of a small or large employer, regardless of the number of hours the sole proprietor or partner works weekly, but only if the plan includes at least two other eligible employees who work on a full-time basis and who usually work at least 30 hours a week.
In Texas, retirees are not eligible on small group plans.
Health insurance is a contract between a policy holder and a health insurance company that requires the insurance company to pay or reimburse some or all of a member’s health care costs for covered services. Learn more about how insurance works.
Deductibles, coinsurance, and copays are all mechanisms that allow health insurance companies and individuals to share costs. Deductible is a fixed amount an employee is required to pay before reimbursement by the health plan (coinsurance) begins. Coinsurance is the percentage of the cost of a covered health care service the employee is responsible for paying after they’ve met their deductible. Premium is the monthly amount that must be paid for a health insurance plan. Copay is the fixed dollar amount a member is required to pay for covered services or prescriptions at the time you receive them. Learn more about how insurance works.
This is the most employees have to pay out of their own pocket for expenses under the insurance plan during the year. Learn more about how insurance works.
Doctors, hospitals, or other providers who accept your employees’ health insurance plans are “in-network,” also known as participating providers. Doctors who do not take these plans are “out-of-network.” In-network provider services are paid at a higher benefit level. Learn more about how insurance works.
Our network plan offerings are built to create health insurance coverage options that fit any budget across different metallic coverage tiers. For more detail on the networks available to you, visit our Plan Options page.
A Smart network is a group of providers that encompass a specific geographical area, and is less broad than a standard PPO network. Plans with a smaller network typically have lower premiums. Learn more about how insurance works.
Essential health benefits are included in every health plan, no matter which plan you choose. The Affordable Care Act requires these benefits to be included in all individual, family, and employer-sponsored plans. Visit our Plan Options page to see all essential health benefits included in our plans.
BCBSTX plans provide comprehensive benefits with options to fit your employees’ needs and your organization’s budget. For more detail on the plans available to you, visit our Plan Options page.
Employers offering group coverage are required to pay at least 50% of their employees’ premiums. You may pay a higher percentage if you choose; making insurance more affordable for your employees can increase participation. If you are new to BCBSTX and purchase small group coverage between November 1 and December 15 for a January 1 or January 15 effective date, the minimum contribution requirement is waived. Learn more about the benefits of offering health insurance.
You can apply for health coverage at any time throughout the year. If you purchase group coverage between November 1 and December 15 for a January 1 or January 15 effective date, the minimum amount you are required to contribute towards your employees’ premium, as well as the number of employees required to participate - are waived.
Each policy has a 12-month contract term. We will reach out to you before the contract term expires to discuss your options for renewing your policy.
You can buy coverage any time during the year and indicate a desired coverage start date. Once your business is approved for coverage, you will receive a notice confirming the date on which your coverage will begin. It will be effective for all enrolled employees starting on that date.
Yes, you may be eligible to take a deduction on the amount you contribute towards the premium cost on your employees behalf. Please contact your tax professional for more details on the tax advantages you may qualify for by offering your employees health insurance.
It is possible. You can take a pre-tax deduction from employees’ paychecks to cover the portion of the total premium that they are required to pay. This deduction reduces their taxable income and the amount of income taxes owed.
Through the Affordable Care Act, individuals may be eligible for subsidies for purchasing coverage through the individual market place if they meet income requirements. If you have additional questions, please contact your tax professional for more information.
Group insurance policies allow employers to offer their employees and their dependents a wider choice of options, with access to more robust plans and larger networks. Monthly premium costs are shared between the employer and the employee.
In the individual market place, there may be fewer options to choose from, plans typically have a higher deductible and smaller networks, and employees are responsible for 100% of the monthly premium.
Yes, coverage can be extended to spouses and/or children of any employees who enroll in coverage. You can decide if you want to contribute to the cost of their coverage.
We offer plans that include out-of-state coverage. If you have employees that reside out of state, you should consider including one of these plans. To find out which plans offer out-of-state coverage, review our 2022 Small Group Plans.
Our insurance specialists can answer any additional questions you may have as you consider your group health insurance options. Call us at 833-923-1785.
To get a quote for your health insurance, simply give us a call at 833-923-1785 or you can get a quote online .
Health insurance includes coverage for a wide range of medical care. However, health care plans only include pediatric dental coverage. Dental insurance can help you and your employees access quality dental care.
Dental insurance includes coverage for oral care, such as regular check-ups, orthodontics, oral surgery, and other dental services. Like health insurance, dental insurance includes networks, coinsurance, deductibles, and annual out-of-pocket maximums.
All health care plans include pediatric dental coverage. However, coverage for adults is only available through a dental insurance plan.
Combining health and dental coverage through BCBSTX streamlines the administration of both programs, helping you manage your overall benefit costs. Employees with both BCBSTX health and dental plans have access to BlueCare Dental ConnectionSM, which includes educational information and outreach to help your employees make important decisions about their dental care.
Members who have health and dental insurance have experienced:
• 24% reduction in medical costs
• 41% fewer hospital admissions
• 34% fewer ER visits
You can choose to offer a contributory or voluntary dental plan to your employees. If you choose a contributory dental plan, you must contribute at least 50% towards your employees’ dental insurance premiums. For voluntary plans, you are not required to contribute towards your employees’ premiums, but you have the option to contribute up to 49%.
To purchase BCBSTX dental insurance, you must purchase BCBSTX health insurance.