Texas Employer Health Insurance
Employers in Texas are able to save, find, compare, and enroll in group health insurance with Sanus Benefits. Pricing and plan options vary depending on plan type, geographic location, and overall health of group. We give you access to all options in the marketplace including proprietary options like the Association of General Contractors Health Plan. We offer Fully Insured Health Plans, Level Self Funded Plans, Self Funded Plans, Limited Benefit Plans, and Reference Based Pricing Options. Depending on your group, any one of these options can be a good choice for you and your employees.
Thats where Sanus Benefits comes in. We have worked with over 1,000 employers in Texas on their Employee Benefit Options. We are a trusted partner that is not driven by profits but instead by customer satisfaction. You can apply for Group Health Insurance Coverage at anytime of the year. You do not need to wait until renewal to start saving.
Benefits Compliance Resource
When offering group health insurance coverage you need a partner that is knowledgeable on the current mandates surrounding Employer Sponsored Health Insurance in Texas. There are certain mandates that need to be shown to employees at renewal, along with certain plan information that is sometimes overlooked by other brokers. Texas Employers can rest easy with Sanus Benefits, knowing we provide: a benefits booklet at enrollment that goes over the required mandates, Regular Compliance Updates, HIPPA certified brokers, and employer compliance documents. An example of an employer compliance document is Section 125 Documenation. Whenever an employer is offering Health Insurance pre-tax they are required to have Section 125 Documentation on file. If an employer does not have that documentation they are putting themselves at risk for thousands of dollars in fines. Another compliance requirement often overlooked is registration in the CMS (Center of Medicaid Services) system. These are all essential when offering benefits. To read more on compliance resources offered through Sanus Benefits visit Texas Compliance Resource.
Health Insurance Plan Types
There are numerous plan types for employer health insurance in Texas. It is hard for employers to decipher their meaning and the best option for their group. There are PPO, HMO, and EPO plan types. PPO Health Plans are the least restrictive of these options. PPO plans generally have affordable copays, and a wide selection of providers/doctors. If your employees are adamant on using their doctor then I highly recommend a PPO option. Unlike the other options, PPO plan types even offer coverage for Out of Network Providers. EPO plans generally have the same network size as PPO plans (They use the same in-network doctors). However EPO Plans, do not offer out of network coverage. HMO plans are the most restrictive of the three plan options. HMO plans sometimes require employees to designate a primary care provider, and only go to specialist he/she recommends. However, not all HMO options have this restriction. Either way, HMO networks are the smallest in comparison with EPO and PPO plans. In addition to having the smallest network, HMO plans like EPO plans do not offer coverage to out of-network providers. This is just a quick synopsis of differences. To get exact details on your plan type I would recommend reviewing the SBC (Summary Of Benefits And Coverage). The SBC will show your coverage details, and plan type.
Texas Employer Health Insurance Market
The Texas Health Insurance industry is very competitive and complex. The most affordable Health Plan in Austin Texas, can very well be the highest costing plan in Houston Texas. Price is not the only difference, some carriers are not available statewide or use an alternative network when out of their coverage area. Like Memorial Hermann for example, they offer coverage to only Houston headquartered businesses. If employees are outside of Houston, they use the PHCS network. These are important aspects of the market that Sanus Benefit takes careful note of. The last thing you want to hear as a covered individual is "It shows you do not have coverage".
Our comprehensive Texas Employer Health Insurance Market Reivew via our group quoting portal will include these details and more to make sure you receive the best deal for your wallet as well as your health.
Medical Plan Options
Not only do employers need to be aware of the plan types (PPO, HMO, EPO) they also need to be cognizant of the funding type. This is a term you do not hear from most brokers but it is very important. There are Fully Insured plans, Level Self Funded Plans, Self Funded Plans, and Reference Based Pricing plans. What do these different funding options mean?
Fully Insured Plan Options
- these options comply with both state and federal mandated benefits. Meaning all plan options are required to offer all State and Federal coverage requirements. These plans are subject to community rating on groups under 50 employees. Community rating means that your group is strictly rated based off census information (Age/Gender/Residential Zip Code) that is it. Because of the limitations in information they can gather, the rates sky rocket. There is no way to differentiate a healthy group from a sick group using this option. This leads to extremely high premiums for very crappy plans.Level Self Funded Plan Options
- involves the employer taking on more risk for claims than a fully insured plan. However, it provides more financial predictability and lesser risk than paying claims directly, like a typical self-funded plan. To quote this plan option, an actuarial firm reviews an employers prior claim experience, and generates a rate for the group based off claim estimations for the next year. This rate includes a claim fund, administrative expenses, and network costs. These plan options often offer a refund at the end of the year if your group has lower claims than anticipated. They are also generally more affordable than fully insured options for groups under 50 employees, or groups over 50 with limited participation.Self Funded Plan Options
- these options are often best suited for employers with a substantial amount of savings set aside for claim payments. These plans offer the most flexibility with coverage types, and plan set up. As well as offer claim details that you are unable to pull from the carrier directly. However they do require more work to maintain. There are numerous cogs so to say in a self funded plan option. You will need to 'Rent a Network', find a reliable Claim Administrator, Quote various Stop Loss options (As well as understand what stop loss coverage is), assess the amount of risk your employer is willing to take on, and find a reliable broker that quotes these various options year to year to verify you are still receiving the best price (Sanus Benefits). We also offer a quarterly review to discuss prior claims and simple strategies self funded employers can take to lower future claim costs.Reference Based Pricing Plan Options
- these are plans without a network. Instead of paying set network prices, they pay at a percentage of Medicaid. According to carriers that offer these options, 95% of providers take the payment without issue. In the case of a provider not accepting the slightly higher percentage of what medicaid pays, the carrier has a negotiation team that calls and works out the lowest price they are willing to accept. While this option offers the most saving potential, they are often too difficult to administer.This is just a quick summary of each funding option. To find out which funding type each carrier offers see below.
Texas Health Insurance Plan Types
| Carrier | Available Statewide | Fully Insured Plans | Level Self Funded Plans | RBP* Plans |
|---|---|---|---|---|
| Blue Cross Blue Shield | Yes | Yes | Yes (Blue Balance) | No |
| United Healthcare | Yes | Yes | Yes (All Savers) | No |
| Humana | Yes | Yes | Yes | No |
| Aetna | Yes | Yes | Yes | No |
| Cigna | Yes | Yes | Yes | No |
| All State | Yes | Yes | Yes | Yes |
| Memorial Hermann | No *Houston | Yes | No | No |
| Association of General Contractors Health Plan | Yes | Yes | Yes | No |
*RBP - Reference Based Pricing *Memorial Hermann allows groups that have employees out of the Houston area to use the PHCS Network.
Employer Medical Premium Statistics
| Average Monthly Contribution Amount | Percentage Difference | Average Monthly Premium | Percentage Difference | Average Deductible Amount | |
|---|---|---|---|---|---|
| Small Employers 2009* | $355.08 | 0% | $408 | 0% | $1,254 |
| Large Employers 2009* | $337.00 | 0% | $395 | 0% | $640 |
| Small Employers 2020* | $515.33 | +45.14% | $602 | +47.55% | $2,271 |
| Large Employers 2020* | $487.08 | +44.53% | $598 | +51.39% | $1,412 |
| Sanus Benefits Employers | $359.37 | +1.21% | $462 | +13.24% | $3,220 |
*Based on Kaiser Family Foundation 2019 Employer Health Insurance Stats
**Based on Sanus Benefits Current Clients.
Employer Medical Premium Overview
So what inferences are we able to make from the above statistics? The obvious glaring issue/inference is the dramatic rise in premium with Health Insurance for all Employers. How is healthcare going to continue to be affordable for groups if the premium increase has been 50% in overall premium in the past 11 years? A sizable portion of the increase can be attributed to the Affordable Care Act (Enacted March 23 2010), which (depending on who you are asking) is the best/worst legislation for healthcare. However that is not the only cost driver by far. The 2019 Employer Health Benefits Survey by Kaiser Family Foundation, found that premiums are increasing by an average of 4-5% each year. Which is surpassing the rate of inflation ( 1.81% 2019) and wage growth (4% 2019). This is a conundrum which has no easy answer. Most groups just cut the benefits more and more each year which is why you see the increase in deductible, or they force the employee to pay more to participate.
How has Sanus Benefits shown their customers such affordable rates compared to the market norm for 2019?
Our most notable differentiator is our willingness to come up with creative solutions. There is not a single fool proof method to save on premium other than cutting benefits. However as you probably can infer, that method is not going to last (the deductible can only go so high). We are knowledgeable on a multitude of different cost saving strategies and unique marketplace options any of which could be the best option for your group depending on your needs. Some of these strategies can be implemented overnight, others do not start showing their benefits until a year or two later. The longterm strategy is often over looked by our counterparts but it has proven pivotal in premium savings and overall health of employees. That is a high level overview of how we have enabled our customers to save on their premium without cutting benefits. If you would like a more detailed answer feel free to reach out to us at anytime.
