How to get a PPO!

If you’ve been trying to get insurance during the Open Enrollment, which ends December 15th, you have probably noticed you can’t get a PPO or Preferred Provider Organizations.  PPOs are only offered in the Small and Large Group markets.  The reason why is a topic for a future blog.  This topic is about how to get one if you are looking for insurance.

A small group in the State of Texas is defined as 2 to 50 employee lives.  It can’t be husband and wife, and it can’t be formed for the purposes of getting insurance.  The husband-wife thing has to do with participation.  Insurance Carriers in Texas require that 75% of eligible employees participate in the health plan, or they won’t insure you.  Having said that, a couple of insurance companies will waive the participation rates and allow a husband and wife to apply for insurance as a small group.

First, you must have a company.  A company would be an LLC, C-Corp, S-Corp or any other legal entity recognized by the State.  The company must be registered with the Secretary of State’s office.  A DBA (Doing Business As) doesn’t count.

The advantages are:  You have access to about 5 times as many plan choices including PPOs, the premiums paid are 100% deductible from the company, sometimes they premiums are cheaper and providers are more willing to take a group plan versus an individual plan.  Why providers don’t want individual insurance is a topic for a future blog.

If you think you might qualify and want to see how it might look for you, give me a call  I can answer all your insurance questions.

Ken Stephenson, MBA, FHIAS – 512-417-6058

By Ken Stephenson

Experienced CEO & President with a demonstrated history of working in the hospital, insurance & healthcare industry. Strong business development professional who is skilled in Medicaid, Physician Relations, Public Speaking, Management, and Start-ups.

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