In discussions of group health insurance and employer-provided health insurance in Texas, it is important to include some of the parameters for defining what a “small” business is according to state and federal guidelines. This is especially important because a company’s size can have a direct impact on whether insurance must be offered to employees or not. By definition, a small business is one with no more than 50 full-time staff members. This number only includes those employees who work a minimum of 30 hours a week. Temporary and contract employees are not part of these head counts.
Small employers qualify for some extra legal protection under state and federal laws. This includes dictating how much insurance companies can charge them and what type of coverage must be extended to them. In order for these smaller companies to benefit from the special health insurance statutes in Texas they do have to meet certain eligibility requirements. The total number of employees is not as important as how many employees are eligible for, or will be participating in the insurance program. The law requires that all eligible employees have health insurance offered to them and their immediate families.
A health insurance carrier can mandate that at least three fourths of eligible employees from a small employer seek to get health coverage. With certain carriers, this can be part of how they will get their health care plan. Depending on the number of eligible employees, the law can mandate that not everyone has to participate. This can apply to health insurance in Texas.
Or if the number of employees is low, require them to have total participation of 100%, no exceptions. If the small employer includes spouses and maybe a few others, then the spouses must each get separate health insurance coverage. There would be no dependent sharing for either spouse. This applies to health insurance in Texas as well.
With the small employer, the ones that qualify for health care coverage are bound by the exact terms and conditions. No one can have anything different in their health insurance policy. If it were a larger employer, then the policies would be different. They could be more flexible because they have more people that would need or want coverage. The health insurance in Texas can dictate that.
Regardless of a company’s size, it is never legal for an employer to coerce any employee into participating in health insurance in Texas. It is always the employee’s choice and should not reflect negatively on that individual. And, no individual can be legally disqualified from any group plan or discriminated against because of their age, sex or any medical condition.
The laws regarding health insurance for small businesses are detailed and complex. Health insurance in Texas must be offered to all eligible employees as dictated by the law. Because employees covered by health insurance are healthier and less financially stressed, employers should think of health insurance in Texas as an investment in their company’s fiscal health