Small Business & Individual Health Insurance in Texas FAQ


Small Business & Individual Health Insurance in Texas FAQ
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Question: Can I offer multiple plandesigns to my employees even though I'm a small business?
Answer: Yes. As long as it's with the same insurance carrier.
Question: Is it possible to offer one group plan even though I have employees in several states?
Answer: Yes. Several companies offer plans with nationwide networks.
Question: When does the "deductible" period start?
Answer: The deductible runs on a calendar year and starts over every January. However, some plans may offer a deductible carryover credit, which will allow the deductible to carryover to the next year, if you met the deductible in the last 3 months of the year.
Question: Are there exceptions to this calendar year period for deductibles?
Answer: Yes, be careful of plans that have a deductible "per surgery" or "per illness". These kind of deductions make it hard to protect your total annual risk exposure.
Question: How are preventive visits covered?
Answer: Preventive care is now covered at 100%. Plans after 10/1/2010 are not even subject to a co-pay.

Question: What is a PPO?

Answer: A PPO stands for "preferred provider organization". This means that there is a preferred network of doctors that will offer contracted or discounted rates to the insurance company. You do have the option to go out of the network for care with a PPO.

Question: How do I know if my doctor is in my PPO network?

Answer: Most companies offer an updated directory on their web site. However, it's always best to check with your doctor to make sure they plan on staying on that network.

Question: I am thinking of offering dental benefits to my employees. Since I haven't offered it in the past, will there be a waiting period?

Answer: Some companies offer immediate coverage for basic and major services, even if you have not had previous dental coverage.

Question: I am starting a new company and would like to offer group health insurance to my employees. Is this possible?

Answer: Yes. many insurance companies will offer coverage to a new company, as long as they can provide required documents.

Question: Do you have to be self-employed to have a HSA account?

Answer: You only need 2 full-time employees to write a group plan.
HSA Plans for Groups

Question: How many employees must I have to be able to offer a group plan?

Answer: No, anyone can have an HSA, but you do have to have a HSA compatible health insurance plan first.

Question: Are there rules on when you can contribute to an HSA savings account?

Answer: Yes.

Question: What are the contribution limits for HSA plans?

  • 2019: individual/$3500 family/$7000 (extra $1,000 if 55 or older)
  • 2020: individual/$3550 family/$7100 (extra $1,000 if 55 or older)

Question: Can an employer offer an HSA plan to their employees as a "group" plan?

Answer: You can contribute from January through April 15th of the following year, as long as you haven't exceeded limits per IRS guidelines.

Question: Can I cover my 1099 employees on my group health plan?

Answer: Yes, as long as they are full-time employees and you don't discriminate among them.

Question: Does every group have to offer COBRA?

Answer: No. In Texas, smaller groups are subject to State Continuation for up to 9 months.

Question: I know that in 2014 everyone must have insurance but what if I can't afford it?

Answer: Per the new Health Care reform to age 26, whether the child is married or not.
ACA/Health Exchange Questions

Question: How long can a child stay on their parent's plan?

Answer: Based on your income, you may be eligible for a government subsidy.

Question: Is it true I can ONLY purchase individual health insurance from Nov 1st - Dec 1st?

Answer: Yes, unless you experience a 'qualifying event'.

Question: What if I miss the 'open enrollment' period and don't have a qualifying event? Is nothing available?

Answer: You may qualify for major medical/catastropohic-type plan to protect against unforeseen injury or illness.
Perryman Insurance

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We can offer you a wide variety of insurance plans to meet your individual or small business insurance needs.