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