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Group Health

Group Health Information

What are Group Benefits?

Group health insurance is a single medical policy issued to a group of people, offering uniform healthcare benefits to all members. In most cases, these policies are purchased by employers and offered to eligible employees and their families as part of an employee benefits package. Enrolling in group health insurance generally could cost participants less than what they would pay for an individual healthcare policy for two main reasons:

  1. The risk is spread over the whole group, as opposed to just one individual.
  2. Many employers pay a portion or all of their employees’ premiums.

Nowadays, many employers feel it's imperative to offer a competitive benefits package in order to attract and retain their quality employees. At the same time, employees have come to expect a benefits package as part of their compensation. While health insurance tends to be the cornerstone of a benefits package, many groups offer additional benefits that could include Dental, Vision, Life Insurance, Disability, Supplemental Medical, and Retirement Planning.

Groups are generally classified as Small, Medium, and Large based on the number of employees who are eligible for coverage. Texas insurance law defines a small employer as a business with 2 to 50 employees. A key requirement of small employer status is that coverage must be made available to all qualifying full-time employees and their spouses and dependents under the same terms and conditions. Eligible employees must meet all of the following requirements.....

  • Work 30 hours or more per week
  • Not be a temporary, part-time, or seasonal employee
  • Not be covered by another group health plan, i.e. through their spouse

State law does not require small employers to contribute toward health benefit plan premiums. But, many insurance companies require employers to pay at least 50 percent of the plan’s premiums and have minimum requirements for a percentage of eligible employees to participate in the plan. Employers may choose to pay a higher percentage of premiums than the company requires.

Texas Benefits Advisors
primarily focuses on offering Small-Group Benefits plans to businesses with 2-50 eligible employees.

Health Care Reform Requirements & Tax Credit

Health care reform is beginning to evolve with many of the key components of the Affordable Care Act(ACA) going into effect on January 1, 2014. Part of the ACA carries a requirement for large businesses to offer compliant, affordable health coverage to its employees. A business is classified as 'large' if it has more than 50 full-time and full-time equivalent employees, and this number increases to 100 employees in 2016. If they do not offer coverage a penalty will be imposed beginning in 2015.

There is no requirement for small businesses to offer health coverage to its employees, meaning those with fewer than 50 employees. There will not be a penalty for small businesses that do not offer or provide coverage. In these cases, employees can get their own Individual or Family Health coverage.

Small businesses that provide health care coverage could be eligible for a tax credit that is worth up to 50 percent of premium costs, or 35 percent for tax-exempt employers. Businesses can claim this tax credit based on the following factors.....

  • Have fewer than 25 full-time equivalent employees (May qualify with more than 25 employees if some are part-time)
  • Average annual employee wages paid is below $50,000
  • Pay at least 50% of the premiums for employees at the employee-only coverage rate

As the ACA continues to evolve, requirements could very well change in the future. Texas Benefits Advisors will keep you updated on these changes as they are announced.

How Texas Benefits Advisors Can Help

Shopping for your organization’s benefits package can be an extremely difficult task.  Nowadays, employers are not only offering medical plans, but are also including benefits such as life, disability, long-term care, and retirement planning.  Factor in the Affordable Care Act changes, rate and product changes, and the different insurance companies that offer these benefit plans, one almost doesn’t know where to begin.

The fact is, each organization is unique and has its own unique needs when it comes to the benefits plan it offers.  Once a solution is determined, the process continues with implementation, maintenance and changes, and communication of the plan benefits to employees.  If it sounds like a full-time job in itself, it virtually is.

An employer needs an independent agent such as Texas Benefits Advisors to help navigate through all of these variables, one who will be your partner and your advocate every step of the way.  The most important part of the process is that your organization makes an informed, intelligent decision on the best benefits plan that meets its needs.  

An independent advisor should be there to help determine your organization’s needs, gather all of the appropriate plan information, educate you and your employees on the benefits and options, and address any issues and concerns.  He or she should work with you side-by-side to provide an unbiased recommendation for the benefit plan(s) to meet your organization’s unique needs, and then carry out the process to implement the plan.

Your advisor should be viewed as an extension of your organization, and the relationship is only beginning after your benefits plan is implemented.  He or she should assist with employee enrollment and disenrollment, questions and concerns with medical claims, education on changes in the healthcare environment, and helping to make sure your benefits package remains competitive and cost-effective.

Contact Us today to discuss your needs and see how Texas Benefits Advisors can help.

Buying Health Coverage

Small businesses have two options when it comes to purchasing their small-group medical coverage. As an independent broker, we can work with you to setup your medical and other benefits directly with a private insurance companyTexas Benefits Advisors represents companies such as BlueCross BlueShield of Texas, Humana, Aetna, and United Healthcare, among others to help you find the coverage that meets your needs and budget. We'll be with you and your employees every step of the way from submitting your group's demographics to obtain quotes, to helping you define the right coverage and submitting enrollment documentation, and to being your liaison to address customer service items with the insurance companies. Come the annual renewal for your benefits, we'll be there with you to compare all your options to help ensure you continue to maintain a quality and affordable plan.

The second option is for a small business to purchase their health coverage through the Marketplace. For now, the federal government operates the insurance marketplace for Texas, and small businesses with fewer than 50 employees(increases to 100 employees in 2016) can purchase their coverage through SHOP(Small Business Health Options Program). Texas Benefits Advisors is certified by the Marketplace to enroll employers into SHOP plans.

With all of the ACA changes, and dependent on your company and employees' situation, it potentially could make more financial sense to have employees setup their own Individual or Family Health plan. A number of companies have instead chosen to go this route with the cost of providing health benefits continuing to escalate. An employee can potentially qualify for a tax credit/subsidy based on their income, and make their health coverage more affordable.

We'd love the opportunity to work with you to help determine the best solution for your business. Please Contact Us to discuss your options in more detail.


Fill out the form below or call us at 512.829.4601
  Texas Benefits Advisors is an independent health and life insurance agency based in the Central Texas Hill Country, with services offered throughout TX. We work with clients in both the under-65 and Medicare markets, including individuals, families, and small businesses. By representing dozens of A-rated companies, you can be sure that working together, we'll help you find the coverage that meets your needs and budget.

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  Phone: 512.829.4601 | TX Lic. #1286049