Information Small Business Owners Need
to Apply for Health Insurance

Enrolling in a small business health insurance plan can be a tedious task, especially if you aren’t prepared with the right documents it takes to be successful. Having all the necessary information will help streamline your journey to health coverage. By the end of this article, you will have a thorough understanding of the Blue Cross Blue Shield of Texas (BCBSTX) enrollment process for small business health insurance.  

Does Your Company Qualify for Small Business Health Insurance?

Before you start thinking about enrolling in a health insurance plan, you must first find out if you qualify. Guidelines vary across states, but there are a few standard requirements small business owners must meet before purchasing a health care plan:

• You employ at least two full-time employees, one of which may include the owner. A full-time employee is considered one who works a minimum of 30 hours a week.
• In the state of Texas, 75% of your full-time eligible employees must select coverage.
• You must contribute a minimum of 50% to your employees’ premiums. Choosing to contribute more can make your plan more affordable, although it is not necessary.

When Can I Apply for My Company’s Healthcare Coverage?

You can apply for healthcare coverage any time of the year. Effective for the entire year, any changes to your plan will need to be made on the anniversary of your coverage start date. However, if you purchase a plan between November 1 and December 15, known as the Waiver Period, some of the requirements previously mentioned above are waived.

During the Waiver Period, plans themselves are not cheaper. The only difference is two standard conditions are waived; you no longer need 75% of employee participation nor is there a minimum premium contribution.

Still have questions? Consult our FAQs or review the insurance basics! If you already match the qualifications, then you’re ready to begin selecting a group health insurance plan!

Requesting a Quote

You can find available, affordable, and attainable coverage options in your area by requesting a free personalized small business quote . Some general information is collected:

• Company name
• Insurance start date
• Company ZIP code (headquarters location) and county
• Number of full-time eligible employees (including yourself)

Learn About Your Group Coverage Options

After populating your credentials, you will enter the age and gender of each of your employees manually or by importing an existing file. Health insurance plans available in your area will be presented with a summary of benefits and estimated costs.

You should evaluate your coverage options by comparing various expenses and filtering for plan types, plan option tiers, and deductible ranges. The estimated monthly costs are calculated based on the assumption that all employees opt for the chosen plan with employee-only coverage. More information, such as adding dependents and chosen premium contributions, will be collected later in the process to tailor a more specific monthly estimate.

After you’ve selected a plan(s) that fit your budget and suits your employees’ needs, you are ready to create an account. Once you’ve registered, your progress is saved, and you are directed to the more comprehensive part of the quoting process where further employee/business details are required.

Adding Dependents

When inputting your additional employee details, this is where you designate dependents for each employee, helping to create a more precise estimate of premium costs. Regardless of whether an employee is waiving coverage, they should still be included in this step.  

Cost Estimates and Contribution Strategy

Cost estimates are broken down based on the provided employee information. For contribution strategy, you can contribute a percentage or a flat dollar amount. Either option must meet the minimum 50% contribution rule (that is, if you are not enrolling during the Waiver Period). This requirement applies to employee coverage only; you may choose to contribute to dependent coverage, although it is optional.

So far so good, right? Once you’ve reviewed your customized quote, you may proceed to enrollment. Let’s dive into the documents you will need.

What Documents Do I Need to Enroll in Small Business Health Insurance? 

To complete the enrollment process, you will need to provide proof of wages documentation for all eligible employees, including yourself. Acceptable wages documentation includes the following:

• Most recent Texas Employer’s Contribution and Wage Report (TWC):: must contain the company’s legal name, current address, and employment status of each employee on the document (full-time, part-time, seasonal, terminated). If your business is new, you likely will not have this document. In its place, a Supplemental Employment Verification form, state filed proof of business, as well as W-4’s for all W-2 employees is required.
• If there are partners or shareholders that are not listed on your most recent quarterly wage and tax statement, you’ll need to provide at least one of the following: most recent Federal Tax Schedule C (Form 1040), most recent quarterly Federal Tax Return (Form 941), or most recent Schedule K-1 (Form 1120-S or 1065)

Missing Documents

If you’re missing any of the above documents or they are unavailable, the following may be considered as alternatives:

• Payroll Report: acceptable for newly hired employees not yet on the contribution and wage report. This report must include the most recent three consecutive months of wages with the company’s legal name, all employee employment status’, employee wage and tax information, and pay period (beginning and end dates/quarter). This must be submitted with a state filed proof of business.
• Employee’s W-4: acceptable for newly hired employees not yet on the payroll report. This must be submitted along with a Supplemental Employee Verification form.
• • Employee’s W-2: accepted only in the first quarter of the year, this document is acceptable if a payroll report or W-4 is unavailable. An explanation of why the preferred documentation is not available must be given.

Waiving Coverage

Have employees who are already insured through an individual plan or elsewhere in the marketplace? After employee details are finalized, the next step is to specify the anticipated enrollment status for each employee. If an employee is declining coverage, a reason must be provided.

Post-Submission

After uploading your proof of wages documentation and electronically signing your group coverage application, your application will be submitted for review, and you’ll be notified of any status changes.

A BCBSTX coverage advisor may reach back out for additional information. If you have questions or need to make a change to an already submitted application, you can call 1-833-923-1785.