TEXAS PPO HEALTH INSURANCE
Are you fed up with the Obamacare HMO Plan that you had to choose this year?
Tired of not having the Doctors that you want to see in your network? Do you want your PPO PLAN BACK. AS OF JANUARY 2017 THE STATE OF TEXAS HAS BROUGHT BACK HUSBAND AND WIFE TWO MAN GROUPS.CALL 512-963-5000 FOR RATES TODAY.
These are true group health plans just like you get when you go to work for a company…and you have to have a company registered as a LLC..Inc..ect..and a partner to qualify for a 2 man group…it can be husband and wife….and rates average $500 and up per person…depending on age..had a group come in at $300 per person…they were 29 and 33…..there is no set rates for group plans…..what I need to run rates is name of the LLC that you and your spouse are listed on with address and phone number and the birthdays of everyone you want on the plan.If you would like more info email me at stibroker1@gmail.com
or call 512-963-5000
This “mom and pop” business model isn’t all that uncommon, and neither are questions about group medical insurance. Many people ask whether or not they can sign up for group medical insurance as a “mom and pop” entity, before they hire additional employees.
So, what’s the answer? Can you buy a group policy now when it’s just you and your spouse? Or will you have to wait until you’ve hired at least one other employee?
The answer to this question can be yes. It can also be no. It depends, in part, on where you’re operating your business. Each state regulates the insurance policies that can be sold within it. These state-defined insurance laws also lay down what qualifies as a “group” for the purpose of purchasing insurance policies.
While the laws do vary, the general rule of thumb is that spouses do not meet the definition of “group.” Unless you have other employees, you and your spouse wouldn’t be considered a group and therefore wouldn’t be eligible to buy group insurance.
One thing that confuses many people is that, previously, some states did allow groups (often termed Husband and Wife Groups) to purchase group insurance. New York, for example, discontinued this practice in 2014.
As a result, you may have heard some of your colleagues talking about being able to do this. You may even be able to dig up old internet posts concerning eligibility of Husband and Wife Groups, even under the Affordable Care Act when it was first introduced.
In the majority of states, you’ll be required to have at least one W-2 employee working for your business before you’ll be eligible for a group insurance policy. Other restrictions include that the W-2 employee is not related to you. This means the employee must not be an owner or a business partner, or the spouse of an owner or business partner.
Once you meet these criteria, you can purchase group insurance.
There are, of course, exceptions to the rule. A handful of states offer exceptions to spouses meeting particular criteria. If you meet these criteria, you can then qualify for group insurance as a small group, even if your “group” consists only of you and your spouse. If you want to know about your state’s particular rules and whether or not you could qualify, you can talk to a carrier, broker, or workforce management consultant. They have deep knowledge of the rules and regulations in your state. Texas does offer Texas PPO Health Insurance Plans.
Why Would You Buy?
The most common reason a business owner wants to purchase group insurance is to get coverage for their own family, including their spouse and children. You can still provide coverage by purchasing individual policies. Group insurance policies often have preferential rates, but you may not qualify. In this case, individual insurance is the next best thing.
A few people are likely trying to be forward thinking by setting up a group insurance policy prior to hiring additional employees. After all, benefits can help you attract more qualified talent to work for your business! If you want to compete with the big guys, you’re going to need a benefits policy. If you could set up a group insurance policy plan before you needed to hire your first W-2 employee, you’d be at an advantage.
Unfortunately, this option isn’t available for most employers. The best idea is to shop around once you know you’ll be hiring a W-2 employee. You can mention you’ll be offering benefits during the hiring process.
Many business owners have a spouse working in the business. Often, that spouse works for no pay or benefits, But, if your spouse works on a regular basis as an employee, you might consider putting your spouse on the payroll as an official employee, for several reasons.
Putting Your Spouse on the Payroll
If you have a compliant spouse who wants to help out and you have enough money coming in from the business and other sources, it might be tempting to have the spouse work in the business but not as an employee.
Your spouse may also be a part-owner of the business, and he or she may receive dividends (if the business is a corporation) or a share of the net income from a partnership or LLC. In this case, if your spouse works on a day-to-day basis in the business you may decide not to pay a salary to this person in addition to the money received as an owner.
But there are some advantages to classifying your spouse as an employee.
Social Security Credit for Spouses as Employees
If your spouse works in your business for no pay, he or she doesn’t accumulate credit towards Social Security. But hiring your spouse as an employee means that he or she will receive Social Security credits toward receiving a Social Security income at retirement. Of course, this also means that FICA tax (Social Security/Medicare) will be withheld from your spouse’s pay and that the business will also have to contribute to this account.
Retirement Benefits
If your business has a retirement plan, your working spouse/employee can receive retirement benefits. The contributions to the retirement plan made by your company are tax deductible, up to 25% of compensation or $49,000, whichever is less.
Health Insurance Coverage for Spouse/Employees
If your business provides health insurance coverage to employees, you may find it cheaper to cover your spouse as an employee rather than as a dependent under your coverage as an employee/owner. The cost of company-paid premiums for your spouse’s health insurance is deductible to the company. You may also want to look at the impact of hiring your spouse on the health care tax credit available to small businesses that pay for health insurance for employees.
Business Travel With Spouse/Employees
If your spouse/employee has a legitimate reason to travel with you on business trips, you can deduct your spouse’s travel costs as a business expense, and your spouse would not have to pay taxes on these travel benefits. Just be sure that you can justify the reason for your spouse to accompany you on a business trip as an employee, and the reason should relate to your spouse’s position with the company. “Holding your luggage” doesn’t count as a legitimate reason for your spouse to go on this trip as an employee, but if your spouse is marketing manager and you are going to a trade show, this could be legitimate.
Life Insurance and Other Benefits for Spouse/Employees
Your spouse/employee can receive any benefits given to other employees, including employer-provided life insurance. Premium costs up to $50,000 of group term life insurance are not taxable to employees and are deductible as a business expense.
What Are the Drawbacks of Treating My Spouse as an Employee?
The principal cost of treating a spouse as an employee are:
- costs of employment taxes, including the amount of FICA tax and unemployment tax that must be paid by the employer, and
- costs of providing employee benefits to your spouse, including costs for putting a spousal employee on the company health care plan and paying for life insurance premiums.
Of course, all of these costs are deductible as business expenses by the company.
If your business is a corporation, consider the difference between your personal tax bracket and the corporate tax bracket when weighing the effect of hiring your spouse as an employee. In other words, look at the difference between the income to your spouse as an employee vs. costs to the corporation of hiring and paying.
A potential drawback may also be issues that arise in the event of a divorce. If your spouse is working in your company and you decide to divorce, check with your tax advisor and attorney about potential issues that may need to be resolved.
Treating Your Spouse as an Employee
If you decide to put your spouse on the payroll as an employee, you must treat him or her as an employee in every way:
- Give your spouse a title and an appropriate salary for that title.
- Have our spouse complete all the required new hire forms and payroll authorizations, the same as any other new employee. Read more about the new hire forms you should have your spouse complete.
- Make all required deductions and withholding from your spouse’s pay, including withholding federal income tax and making FICA deductions.
- Include your spouse/employee in all benefits coverage provided to other employees.
- You should be able to prove that your spouse is actually doing the work for which he or she is being paid.
- If your spouse is also an officer or owner of your business, keep the salaried duties separate from any ownership activities.
Special Circumstance: S Corporation Owners
If you and/or your spouse own more than 2% of an S corporation, some of the benefits of “spouse as an employee” may not be available to you.
Well as of JANUARY 2017 THE STATE OF TEXAS HAS BROUGHT BACK HUSBAND AND WIFE TWO MAN GROUP’S. This means I now can again write husband and wife group health insurance if they have a business and are listed as owners on the LLC. If you are not getting a subsidy and paying full price for your Obamacare HMO plan you can now take back your Heath Insurance and not let the government pick your Doctor’s. Call today 512-963-5000 or email me at STIBROKER1@GMAIL.COM for your custom quotes emailed to you. I have been a Health Insurance Broker for 23 years and I leave no stone upturned we it comes to my clients health insurance needs. That’s right Texas HAS made all the health insurance company’s that are pulling out of the ACA or as it has been called OBAMACARE to bring back Husband and Wife two man groups.Are you sick of not having a PPO to choose from? Well now Texas has reinstated the Husband and Wife two man groups. That’s right you can get the same Health Insurance plans that the big company’s offer. And to top it off the rates are the same as your crappy Obamacare Plan. Call today 512-963-5000 to get your custom quotes emailed to you and you can have a plan with all the doctors you want in your network.
Guaranteed Issuance and Renewability for Mom and Pop Groups (expanded December 1, 2016)
Federal law does not consider a family-run business consisting of a husband and wife to be a small group health plan unless the business employs at least one common law employee who is neither spouse. Based on federal guidance, may a small group carrier refuse to issue new coverage or non-renew existing coverage for a small group that does not meet this federal definition?
No. Under Texas law, a small group carrier must issue coverage, consistent with TIC §1501.151, to a small employer with two or more employees, even if the employees are married to one another. A small group carrier may not non-renew coverage for an existing small group because the state and federal definitions of small group differ. In addition, TIC §1501.108 gives a covered employer the right to renew its group health coverage unless the employer fails to comply with the terms of the plan.
Federal law (42 US Code 300gg-91(e)(1)(B)) allows a state to elect to regulate coverage offered to very small groups as coverage in the small group market, and Texas considers a group of two eligible employees to be a small group, regardless of marital status. The Texas Insurance Code does not exclude spouses from the definition of “eligible employee” or exclude such employees in defining “small employer,” and consistent with this 28 TAC §26.7(d), prohibits a small group carrier from denying two individuals who are married the status of eligible employee solely on the basis that the two individuals are married. Commissioner’s Bulletin # B-0035-01 provides additional guidance regarding this requirement.
You will find many affordable Trumpcare Health Insurance plans for individuals, families and the self-employed in the market place. Many are available online at Stibroker.com It is not hard to find Trumpcare Health Insurance that meet your needs and budget as long as you know where to look and how to effectively shop for good coverage. All the Trumpcare Health Insurance companies in Texas offer low cost, affordable Trumpcare Health Insurance plans to cover the most basic needs as well as catastrophic coverage. You can find affordable Texas Trumpcare Health Insurance plans from Aetna, Blue Cross Blue Shield, Cigna, Humana, United Healthcare and more. Here are just a few to consider.
Here is the paperwork BCBS requires to enroll a new group.
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Small Employer Benefit Program Application (BPA)
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Employee applications
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Signed BCBS quote
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Proof of wages (TWC report or other payroll documents)
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Texas Supplemental Employee Verification form – needs to list out any employees who are not on the TWC report.
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Proof of business – required only in TWC is not available
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Employer Group Information form
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EFT form or physical check for 1st month’s premium.
FROM BLUE CROSS BLUE SHIELD HEALTH INSURANCE TEXAS
Small Group (1-50): TDI Updates FAQ on “Mom and
Pop” Businesses
On Dec. 1, 2016, the Texas Department of Insurance (TDI) issued and expanded its
Frequently Asked Questions (FAQs) related to “Mom and Pop” groups.
Under the FAQs, TDI specifies that issuers cannot refuse to accept or non-renew
businesses comprised solely of two employees who are married to each other, for small
group (1-50) coverage.
Documentation Requirements
Paperwork submission requirements have not changed. Please continue to submit the
Employer Group Information (EGI) form and other required documents. We request that
producers with businesses applying for new coverage on or after Dec. 1, 2016, who are
impacted by this FAQ (i.e., businesses comprised solely of two employees who are
married to each other), include a note with the case submission indicating that the
applicants are married to each other.
For additional questions, please contact your Blue Cross and Blue Shield of Texas
Sales Representative.
AND FROM HUMANA HEALTH INSURANCE TEXAS
New eligibility rules for ‘family member’ small-group medical accounts require operational changes
Humana recently announced we’ll no longer accept small medical groups IF all the enrolling subscribers of a wholly owned business consist of the business owner and/or the business owner’s spouse (opposite or same sex). Based on federal guidance these groups are not considered valid groups for the purpose of health insurance, and should be referred to the individual market for coverage options. The one exception to this policy is the State of Texas, where we will write small group medical coverage to a husband and wife group where both of the spouses are employees (subject to receiving legal documentation to verify employee status). This change aligns with the policy for other carriers in the industry and is effective immediately.
Effective Dec. 1, 2016, Underwriting and Group Maintenance will require the Small Employer Attestation for Group Medical Coverage on groups of five or fewer enrolled subscribers. If you don’t submit the attestation with the new case enrollment material or medical plan add, we’ll request the attestation as “missing information.” If we still do not receive the attestation after 48 hours, we will withdraw the new case or medical plan add. This requirement affects group commercial medical only and does not apply to dental, vision or ancillary products.
Help us comply with federal small group medical eligibility rules. We created the form to avoid a wage and tax requirement for groups applying for medical coverage. Underwriting reserves the right to request Wage and Tax Statements (Form W-2) or a Schedule K-1 (Form 1065). A wage and tax does not take the place of the Small Employer Attestation for Group Medical Coverage form.
You’ll find the Small Employer Attestation for Group Medical Coverage on the Agent portal under Marketing Materials.
Please contact your Sales Executive if you have any questions regarding this change.
