Texas Capitol Building
 
Quality, Affordable Health Insurance and
Benefits for your Small Business
 
 
 
Need help?
Contact us at
(512)
447-9853
CLICK HERE
to receive an 'information packet' and the forms for obtaining projected Group Health
rates
CLICK HERE
to compare the products and plans of multiple carriers for individual coverage.

 
Eligibility Requirements

For purposes of small group health insurance, a small employer is defined as a business that has 2 to 150 employees. Employees include business owners, partners in a partnership, and officers and directors of a corporation, as well as other hourly and salaried employees.

The following are the small employer eligibilty requirements for group health insurance in Texas:

At least 2 full-time eligible employees must participate in a small group health insurance plan offered by their employer in order for a small employer group to qualify for small group health insurance and participation in a small employer health coalition.

 
  • Full-time employees are defined as those employees who work 30 hours or more weekly.
  • Eligible employees can include a business owner, partners, officers and directors of a corporation and W2 employees.
  • Full-time 1099 contract employees can participate in a qualified small group health insurance plan or small employer health coalition but cannot count toward the 'eligible employee' requirement.
A minimum number/percentage of full-time eligible employees must participate in the small group health insurance plan offered by their employer as follows. These same requirements apply to participation in a small employer health coalition. Two full-time eligible spouses working for a business count as two employees and must enroll for coverage separately.

  • When there are only 2 full-time eligible employees, both must participate.
  • A business with 3 full-time eligible employees must have at least 2 participate.
  • For a business with 4 or more full-time eligible employees, at least 75% of the full-time eligible employees who do not have individual or group health insurance elsewhere must participate. Full-time employees who have individual or group health insurance elsewhere are excluded from the 75% participation requirement while some carriers exclude only those employees who have group health insurance elsewhere.
Insurance companies insuring small employer groups are allowed to require an employer to pay at least 50% of the premiums for 'employee-only' coverage.
 
Employers must provide an insurer verification of the legal existence of their businesses and a list of of employees. The preferred document is a copy of the employer's most recent quarterly Wage & Tax Report that has been filed with the Texas Workforce Commission. When a Wage & Tax Report is not available, it will be necessary to provide the insurance company other doucmentation that verifies the existence of the business, and verification of an income-earning capacity of each full-time eligible employee that applies for coverage.
 
Please contact us if you have questions or need additional assistance.
 

Thank you for this opportunity to be of service!
 
 
 
Business owners
We can help you with...
 

Sole Proprietors
We can help you with...
 

Individuals
We can help you with...
 
         
.
             
             

Copyright © 2009-2011 Small Employeer Benefits, L.P. - All rights reserved
Website by CRBoyd, LLC - Austin, TX