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Frequently Asked Questions

If you’re considering providing health care coverage for your employees, we’re here to help. We’ve shared answers to some of the most common questions small business owners have about health insurance coverage below.

To qualify for group coverage as a small business, your company needs between two and 50 full-time employees (including the owner). A full-time employee is defined as someone that works at least 30 hours per week. Some states have additional guidelines as to who qualifies as a full-time employee, and have minimum participation requirements. For guidance on other qualifiers, call 833-923-1785.

If you purchase insurance between November 1 and December 15 for a January 1 effective date, this participation requirement is waived.

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.

HMO (Health Maintenance Organization) plans typically require members to select a primary care physician (PCP) to coordinate care within the network. In order to see a specialist, members may need a referral from their PCP. Having care coordinated by a PCP may result in lower overall costs for the member. PPO (Participating Provider Option) plans do not require members to select a primary care physician, and in most cases, members can go to any provider within the network without a referral. This increase in flexibility may result in a higher overall cost for the member. Learn more about how insurance works.

Generally, the higher a plan’s deductible, the lower its premium. Plans with higher deductibles have lower monthly costs but may make expenses less predictable if medical bills accumulate suddenly. If you choose a plan with a lower deductible, it will generally have a higher premium. Plans with lower deductibles allow employees to better control unpredictable costs when they need their insurance.

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 purchase group coverage between November 1 and December 15 for a January 1 effective date, the minimum contribution requirement is waived. Learn more about the benefits of offering health insurance.

The cost of health insurance for your small business will depend on the type of plan you choose as well as your contribution strategy. Most states require a minimum contribution for group coverage.

If you purchase group coverage between November 1 and December 15 for a January 1 effective date, your contribution requirements 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 2020 Small Group Plans. pdf link

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 Leaving Site Icon.

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Get in Touch by Phone
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Bliue Cross and Blue Shield of Texas
Market leader for over 80 years.
Pioneering industry change.
Most widely accepted by doctors and specialists.
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