In Texas, small group coverage (under fifty employees) insurance carriers require that 75% of all full-time eligible employees must opt for coverage in the company's group health plan. Eligible employees who can substantiate that they waive coverage because they are covered under a spouse's group (not individual) health plan do not count towards the 75%, but eligible employees who decline coverage do count against 75% particpation.

But small business owners with Subchapter S or LLC forms of business do not have to pay themselves a wage through payroll, can instead receive a portion of the business' income on their own personal tax schedule, and can decide whether or not to be in their company's group health plan. If a small business owner with these forms of business chooses not to be covered by their Texas small business group health plan, they do not count as a "decline" in the 75% calculation.

Here are a few situations where a small business owner with Subchapter S or LLC would decide to decline coverage in the business' group health plan:
–If the business owner's own and dependent's health were fine, the business owner could select an individual health plan with different level of (higher or lower) benefits than the business' group health plan, and possibly at a lower monthly premium expense than the business' group health plan premium.
–If the business' owner's own or their dependent's health is impaired with serious pre-existing conditions and if the owner's spouse is eligible for a group health plan, then by obtaining coverage through the spouse's plan, the business owner can transfer the underwriting risk/expense from the owner's plan to the spouse's plan.

Since Texas small group health insurance carriers can charge up to two thirds higher than standard premiums based on the underwriting risk of the pre-existing conditions of the eligible employees and dependents, by transferring the risk out of the company's group health plan, the business owner could possibly receive a reduction in the company's group health plan premiums, or put the company in a better position to shop for lower cost coverage with a different carrier at renewal time.

For more smart tips on how Texas small businesses owners can control the cost of their employee benefits and group health insurance, contact Michael Chapman of TexasGroupBenefits.com at 214-764-6315 or (888) 398-6246.

Most small businesses in Dallas, Texas and in other communities such as Fort Worth and Arlington, TX have reached the end of the line for being able to afford a group health insurance plan for their employees.  Recent surveys have shown that less than 35 percent of area small businesses of 100 employees or less now offer group health insurance benefits to their employees.  

Even for group plans with deductibles that now range from $2,000 to $5,000 per person, the cost to cover a middle aged husband and wife in a Dallas group health plan usually exceeds $1,000 per month, and the monthly cost to cover a family of four can now easily exceed $1,500 per month.  

Fewer small businesses can afford any longer to cover all of the employee's group health insurance premium.   Even fewer businesses can afford to cover any portion of the dependents' insurance premium.  

As a result, even fewer employees can afford the equivalent of another house payment to insure their loved ones. The result is a steady increase in the uninsured levels in Dallas County, and a strain on the public health care system.

Part of the reason that health insurance is so darned expensive is that area health care is so expensive. It is really getting hard for Dallas County general hospitals to make a buck.  Not enough paying customers, too many nonpaying customers, too much government red tape and interference in the prices hospitals can charge, and insurance companies that will reimburse based on what a hospital procedure should cost, not what it actually costs.  And there are just way too many hospitals and beds in Dallas County for the number of paying customers and what they are able to pay. 

Another reason is that in Dallas County as elsewhere, there is a steady increase in the number of individuals with government sponsored health care plans, whether government employee plans, Medicare, Medicaid, TriCare, CHIPS, etc.  These plans' reimbursement rates to doctors and hospitals are fixed by the government.  The record keeping costs to hospitals and doctors that accept these plans is so high, and the reimbursement so low, that many of the providers who can do so no longer accept patients who have this type of plan coverage.

And finally, government regulations prohibit area general hospitals from refusing trauma and emergency care to patients who are unable to pay.  Since it costs area hospitals more to provide indigent care than they get back in government reimbursement, the additional cost  ends up getting buried in what these hospitals charge paying customers.

In the private sector, too many stores or too much office space or too many hotel beds in a declining market would lead to store, office building or hotel closings.  Mergers, acquisitions, or consolidations in a sick industry would presumably lead to stronger, healthier competitors.  Not so, (at least yet) when it comes to general hospitals. 

There have been no hospital closings in Dallas County in recent memory, in spite of the decline in the number of individuals with health insurance, and the rising unreimbursed cost of health care.  In fact, there has been an increase in the total number of hospitals in Dallas County. Not necessarily in the number of general hospitals, but in the number of specialty hospitals. 

Much like how specialty retailers (think Costco/Lowes/Target/Amazon) have flourished while general merchandise retailers (think Montgomery Wards/Sears) are practically extinct,  specialty hospitals such as orthopedic, cardiac, and cosmetic surgery have grown in Dallas.  A specialty hospital, with lower operating costs, siphons off paying customers and the more profitable health care procedures from the general hospitals.

This now brings us to the question about what to do about  Dallas County's Parkland Hospital.  This has truly been a wonderful community asset, and it is one of the finest teaching hospitals in the world, whose mission has been to provide low or no cost health care services to Dallas county residents who cannot afford to pay for their health care.  Businesses and property owners pay taxes to support Parkland's budget.  The average homeowner in Dallas County pays about $400 in taxes per year to support Parkland, though most have probably never set foot inside the hospital. 

The delicate political problem and the financial decision that now must be made is that Parkland is reaching the end of its useful life and the cost of its replacement has been reported to be as high as $1.2 billion.  But the same building materials inflation that have tripled estimates for the DART light rail expansion will no doubt affect Parkland replacement, so don't be surprised if the final replacement figure is north of $4 billion.

The question that should be raised is not whether Parkland should be replaced, but what health care services are needed in Dallas County to serve the needs of its residents, and are there already enough general and specialty hospitals to serve the needs of the community. 

Perhaps a specialized trauma center, burn center or a birthing center, with presumably lower operating costs, is what is needed.  Perhaps these facilities could be operated more efficiently if they were privately owned and operated and required less public subsidy than if they were owned and operated by Dallas County.   And perhaps some of the existing non-profit and for-profit general hospitals would become more cost efficient if they were able to operate at a higher capacity level. 

If we can let private companies build and operate our local highways, surely we should ask elected officials to study whether the exisitng private operators that have capacity could do a better job providing needed quality health care for our residents at a lower cost, and with less tax payer invstment.

Taxes, health care quality and cost, and health insurance costs are significant factors in any business's  decision to relocate or remain in Dallas County, regardless of their size.  Health care efficiency helps reduce the overall cost of health care, and in turn reduces the cost of health insurance. 

A community like Dallas has so much to offer prospective businesses.  Being able to offer affordable health care and affordable group health insurance with stable premiums would be another big inducement for employers to relocate here.  By attacking cost inefficiency and over capacity, officials might reduce the percentage of uninsured in the community, getting more citizens off of public health care and on to employer provided or individual health insurance plans. 

No public official that values their job wants to come out against replacing Parkland. But replacing the grande old dame Parkland with a bigger and much more expensive general hospital without considering other public/private health options that might provide better care at a lower cost and lower investment  is a huge mistake. 

Not discussing this touchy political question could lead to missing an opportunity and a less hopeful future for Dallas.  With fewer businesses moving to town for fear of higher taxes and ridiculous health insurance costs, the continued downward spiral of employer-provided health insurance for the citizens of Dallas, and an escalation in the number of residents who rely on the government for their health care. 

OK, now that the question is out in the open and the fork in the road has been identified, let's hope that community leaders take it.  Let brighter minds review alternatives that could build a stronger community by lowering the cost of health care and helping to make health insurance affordable for more businesses and residents in Dallas.

Yes, this is the time of year that many companies have open enrollment when employees must choose their health insurance plan, but higher rates for health insurance  hardly constitutes "news."

In fact, Mr. Roberson grossly underestimates the severity of the problem for area employers, especially small to medium sized businesses and their employees.  While the average national group health insurance rate increases may be near 7%, the rates in the Dallas Fort Worth metroplex are much higher than the national averages quoted.

The reasons for the higher local rates are many.  For example, the Dallas Fort Worth area has one of the highest uninsured populations in the country, and those with insurance end up paying higher rates at least partially because hospitals must charge more to cover the cost of those without insurance.

Another reason that rates are higher for area small to mid size businesses than the national average is that group health insurance costs much more for small to mid-sized businesses than for big businesses that self-fund, or self-insure their employee's health care claims.

And one BIG reason that group health insurance costs more in Dallas and Fort Worth Texas is because we tend to be BIGGER (read fatter) and UNHEALTHIER than the national average.  Fatties have a much higher likelihood of chronic diseases and expensive health insurance claims for diseases like diabetes, heart and circulatory conditions, and stroke.  The fatter us North Texans get, the more health claims, and the more insurance costs us.  Chicken fried steak and gravy, anyone?

All told, from what we've seen this year, small to mid-sized fully insured businesses of under 200 employees are experiencing group health insurance rate increases of 11 to 15% in North Texas, not the national average 7% increase reported on by Mr. Roberson.

So what can a Dallas Fort Worth employer or employee to do now about alarmingly high rate group health insurance rate increases?  For many businesses, the amount of the rate increases are greater than a company's annual profits.

Mr. Roberson throws out a few examples about how nationally, employers are reducing coverage and increasing deductibles, adding more to what employees must pay for coverage.  He also mentions national trends toward a slightly higher adaption of consumer driven health plans such as health savings accounts and health reimbursement arrangements.

But nowhere does Mr. Roberson report on an action plan or an agenda for North Texas employers who desparately want to stop the health insurance hyperinflation that is ruining their company profits. 

With that in mind, here's action items for local Dallas Fort Worth CEOs and presidents who want to tackle this inflationary threat to their business:

• Healthy Employees (and dependents) equal Healthy Profits, and it starts at the top.  Any CEO who is not preaching the gospel according to employee wellness to their management team and employees on a regular basis is missing out on the most actionable strategy that they can adapt to reduce health care and insurance costs, as well as reduce lost time productivity losses.  A dollar spent on a corporate wellness plan can return four dollars in reduced claims and productivity improvement.  It doesn't take a rocket scientist to prove to employees that losing weight is good, and new mid-2007 changes in HIPAA regulations even allow employers to dole out moderate "rewards" and "punishments" to thin or fat employees, within reason and within legal guidelines.  Influencing one employee to lose weight and avoid a single instance of diabetes or one less triple bypass can save a company literally millions in insurance premiums over time, and it is the right thing to do for employees and their families.  And when fit employees begin to understand that fat employees can cost them a ton of money in higher health insurance premiums, wellness becomes self-enforcing in the workplace.
• Weigh the savings of "self-insuring" for the small stuff.  Employers with fully insured health plans can now benefit from Section 105 and HRA plans, which can reduce the total cost of health insurance, and reward employees who don't meet their deductible.  Some insurance cariers now even offer free administration of Health Reimbursement Arrangements.  This now makes it affordable for smaller firms with as few as fifteen employees to save on insurance premiums by selecting a higher deductible plan for their employees, and through the HRA, reimburse employees for a portion of their deductible expenses.  Since most employees never meet their deductible, the company and employees pay less in insurance premiums, and the few that do can get reimbursed tax free through the HRA by the company.
• Politics: Get Local, and get Vocal.  Forget about HillaryCare in 2009 or 2010.  That won't help North Texans now.  Until elected officials and government employees are personally subjected to the same type of health insurance issues that taxpayers face,  nothing will change.  Dallas Fort Worth area government employees have unbelievably "rich" health insurance benefits, many with low or no deductibles.  Dallas Fort Worth area government employees also have unbelievably high chronic illness rate and health claims, much of which is attributed to obesity.  There's probably a connection there.  Businesses and taxpayers have the right to expect local government to have the same fiscal awareness and responsibility for health care and insurance claims that they  face, and not just pass on higher government employee health care expenses in the form of higher taxes.  Ridiculously out of touch local government employee health plans with low deductibles and obese and unhealthy government workers should not be tolerated.  Perhaps then we'll see real goverment action about doing something real about the cost of group health insurance and health care.  Business leaders should check out www.DFWBGH.org and get involved.
• Make your group health broker earns their double digit pay increase.  Since group health insurance agents and agencies get paid on a commission basis, there's not a whole lot of built-in incentive for them to work hard to save their clients money.  Don't accept the status quo, and expect quarterly meetings to review initiatives that can reduce health insurance inflation and save your company money.  You won't eliminate group health insurance inflation, but with action, you can take a big bite out of it.

For more information about real, local, and actionable plans that your North Texas company can implement to reduce health insurance cost increases, contact Mike Chapman at Texas Group Benefits, 888-398-6246.

"Which hospitals are in my Arlington Texas group health insurance plan's network? " 

This is a very important factor in selecting an Arlington group health insurance company, because the rates are much higher and the annual deductibles if an employee must go to an out of network hospital.  As an example, a company that offers a group plan with a $1,500 employee deductible plan is very commonplace in the Dallas area.  For most plans, that means that the family deductible is $4,500.  But for many Arlington Texas group health insurance plans, the "out of network" deductible would be three times that amount, or $4,500 or $13,500 for indivdiual or family.  Also, any medical care would be billed at the much higher out of network rate.

Most group health insurance carriers in Arlington, Texas use a preferred provider network  (PPO), which then contracts with indivdual doctors and hospitals in the area.  As shown in the above example, going to a hospital that is "in the PPO network" could save an Arlington employee's family tens of thousands of dollars in expenses vs. going to an out of network provider.

The problem is taht each group health insurance company has its printed and online directory of hospitals that are in their PPO network.  But there isn't any one place that we know of where Arlington employees or employers can see which  hospitals that every major group health insurance company accepts in their PPO network.  

In an emergency, this information could save a company's employees several thousand dollars.  And at renewal time, when a company decides when to change group health insurance carriers, this information can even assist employers decide whether to change companies. 

Selecting your Arlignton company's group health insurance carrier solely on the basis of who has the lowest group health insurance rates in Arlington, Texas could get your company in trouble and could cause poor morale. 

Let's say for example, that your company's Arlington group health insurance broker has recommended that your company consider a health insurance plan for your company simply because it offers very affordable group health insurance quotes in Arlington, Texas. 

But if your Arlington group health insurance agency does not advise you which hospitals are in the recommended carrier's network, this could lead to your selecting a carrier with only a few, distant, or only undesirable hospitals for your employees to visit. 

And if employees as a result had to visit better or closer hospitals that were not in the insurance plan's network, employees could suffer the big financial penalty of out of network rates.

So as a community service and for the convenience of our Dallas group health insurance clients we will post from time to time an unauthorized list of the preferred "in-network hospitals" for many of the most popular group insurance plans in various communities around Dallas Fort Worth, Texas. 

This list is unofficial and is based on the information that we obtained from the group health insurance company websites themselves, but it is subject to change without notice, so we take no responsibility for this information. 

But it is as accurate a list as is available in the community.  Individuals are urged to check with their insurance plan or their local hospital to confirm this list prior to seeking care.  The phone number and address of every general hospital is listed for convenience, so call first to confirm.

This weeks post focuses on Arlington, Texas and we are listing which PPO currently accepts each hospital in network:

1. Arlington Memorial Hospital, 800 W. Randol Mill Rd., Arlington, TX 76012, (817) 548-6100. 
   1. Aetna
   2. Beech Street
   3. Blue Cross Blue Shield of Texas
   4. Great West
   5. PHCS
   6. Unicare
   7. United Healthcare
2. Medical Center of Arlington, 331 Matlock Rd., Arlington, TX 76015, (817) 465-3241.
   1. Aetna
   2. Beech Street
   3. Great West
   4. PHCS
   5. United Healthcare
3. USMD Surgical Hospital of Arlington LP, 801 West I-20, Arlington, TX 76017, (817-472-3000. 
   1. Aetna
   2. Beech Street
   3. Blue Cross Blue Shield of Texas
   4. Great West
   5. PHCS
   6. Unicare
   7. United Healthcare
4.  Kindred Hospital Arlington,   1000 N. Cooper St., Arlington, TX 76011, (817) 548-3000.
   1. Beech Street
   2. Great West
   3. Unicare
   4. United Healthcare

If your Arlington group health insurance plan utilizes another PPO other than the above, please let us know so we can update the above listing.

But unlike the home project you completed yourself, your Dallas group health insurance broker can do all of the work for you.  Your group health insurance company and your Texas group health insurance agency will probably grumble about this approach, because it takes some extra work on their part, and they end up making a lot less money on your compnay's business.

Here's how it works.  You know that group health insurance plan that you have for your employees?  Just like the last automobile you bought, it came pre-packaged with add-on benefits like a prescription drug copay benefit and doctor visit copay benefits. You selected a deductible and coinsurance, found out what it cost, and split a portion of the cost with your employees.

Yes, you can design a "build it yourself" Texas fully insured major medical group health insurance plan for your employees that will give them the same benefits as they have now, but you could save as much as 25 to 40% in premiums each year, and get lower rate increases in future years.  How much could your business save if you were able to reduce your group health premiums by even half that amount?  Now remember, your Dallas group health insurance broker is going to resist this and tell you it can't be done, because they will do a lot more work for a lot less in commission, so put your foot down and insist on reviewing a "DIY" style group health insurance proposal if you get resistance.

Here's the basic "Do It Yourself" fomula for saving up to 40% on your Dallas group health insurance rates.  These are the building blocks you can use that will allow you to save your company and your employees big bucks, and quite possibly have even better group health insurance coveage than you offer now:

• Start with a fully insured high deductible major medical group health insurance plan from any of the top carriers in Texas, including Blue Cross Blue Shield, United Healthcare, Aetna or Unicare.  These four carriers represent over two thirds of the small group health insurance market in the Dallas Fort Worth metroplex.
• The group health insurance plan you select should be "HSA eligible" and have a high deductible of between $2,500 to $5,000 per individual, and between $5,000 to $10,000 per family.  The family deductible should also be an "aggregate" deductible, which means there is one shared deductible for the entire family. 
• This type of plan does not have as a benefit a prescription Rx copay benefit or a doctors office copay benefit until the employee or employee's family have met their annual deductible.  An "HSA eligible" plan does not mean that you have to set up an HSA (health savings account); it merely means that the plan allows you to have one if you so choose.
• You'll notice that the monthly premiums for this type of Texas group health insurance plan are very cheap.  Its probably about half of what your company is paying now.  That's one of the ways you'll save a lot of money.  Don't faint or worry about the high deductible and the lack of copay benefits, because you will reduce the out of pocket risk of each employee and family outside of the plan you select.
• Next,  work with your broker to design a Health Reimbursement Arrangement or HRA, using a very affordable third party administrator.  What the HRA does is reimburse employees for a certain amount of eligible medical expenses after they reach a certain level of out of pocket expenses.  For instance, if your company has a $1,000 deductible plan, you can select a higher deductible plan and then use the HRA to reimburse employees for any eligible medical expenses between between the new deductible and the old deductible.  You save a lot of money because statistically, about two thirds of employees never meet their deductible level, so you're paying for health care coverage that is not often used.  The HRA allows you to offer the same or better coverage to employees, but your company will be writing smaller checks to your group health insurance company.
• Next, what you can do is purchase a medical gap insurance plan from Colonial Life and Accident for your employees that pays employees and their dependents cash, anywhere from $500 to $3000, to cover major medical expenses.  Again, what the medical gap plan does is lower the out of pocket expense risk to employees and dependents at a lower cost than if you had a lower deductible group health insurance plan.
• Next, what you can do is purchase a prescription card for your employees to give them a drug benefit.  Prescription costs today make up about 25% of the cost of a group health insurance plan.  We have found really good and affordable prescription drug benefit cards can be purchased for less than what the group health insurance companies charge for this benefit.
• Next, what you can do through your HRA is implement an employee wellness plan.  You're going to be saving so much money on health insurance premiums, that you can take some of that savings to pay for a corporate wellness plan that gives employees incentives for improving their health, whether by taking a comprehensive diagnostic exam, or by participating in a smoking cessation, weight loss, or exercise program.  Even a small business company can reap huge rewards with a wellness program.  Just preventing one cancer, diabetes or heart attack in the company's workforce can ave a company hundreds of thousands of dollars in health care, and lost wages and productivity expenses, and lower health insurance premiums.
• There are a few more building blocks and techniques for the Dallas area group health insurance do it yourselfer.  But the ones above will save a company a lot of money.  The savings is not only the first year, but every year you have the plan.  And since yourTexas group health insurance carrier will be paying fewer claims because you will have fewer employees meeting the higher deductibles, your annual inflationary rate increase will be less than other businesses that prefer to go the pre-packaged route.

There are countless number of variations on the above DIY group health plan design that we would be happy to review with your company. This DIY design strategy allows you the employer to build the plan that you want with the benefits that you want at a big savings over the pre-packaged plans offered by the major Texas group health insurance companies and most Texas group health insurance brokers.

And remember, the best part is that you do not have to do the work yourself.  You can be the general contractor,  and leave the work to your Texas group health insurance broker or agency, or your Dallas Texas employee benefits agency.  Just tell them what you want, and if they grumble or say it can't be done, give us a call for a free, no obligation consultation on your business, including affordable Dallas group health insurance quotes.  Contact Mike Chapman at TexasGroupBenefits.com, (214) 764-6315 or (888) 398-6246.

Here are some suggestions on how to get affordable health insurance in Dallas and surrounding communities such as Fort Worth, Plano, Richardson, Arlington and Irving.

If you are looking for health insurance for your business, you should consider working with a Dallas group health insurance broker that specializes in group health insurance.  Many property and casualty firms or your home or auto insurance brokers may be able to offer your company plans from one or two companies, but chances are they do not have the expertise nor do they represent a wide number of health insurance companies to be able to advise your company and to recommend to yuo the best coverage for your business. 

And even health insurance agents may only specialize in insurance plans for individuals and families, or specialize in senior health insurance, or represent only a few different companies.  A group health insurance broker who specializes in helping companies find affordable health insurance in Dallas Texas, and who represents several different companies is best suited to assisting your business.

The affordable group health insurance brokers at TexasGroupBenefits.com specializes in group medical insurance in Dallas for small to mid-sized businesses.  We also assist larger businesses with large group fully insured insurance plans, self-funded insurance plans and partially self-funded insurance plans.

Many companies today use the internet for research for potential suppliers.  Companies should beware of filling out online forms from out of state websites that promise to provide them with health insurance quotes.  The company information that you provide is often sold and resold by the website to as many as forty to fifty insurance agents of various degrees of expertise who will in turn call the company and request an appointment.

If your company is looking for affordable health insurance in Texas, contact Mike Chapman at TexasGroupBenefits.com, 214-764-6315 or toll-free (888) 398-6246. 

You will be asked a short list of questions and for information about the company and ages of employees and employees that you can be assured will be kept confidential. 

Within less than three days, you will be presented in person with an initial survey of available plans and rates from "A" rated insurance carriers, as well as recommendations that meet your company's objectives. This assures that you are getting the best advice available for your business before you purchase a group health insurance plan.

If you are in Texas and are self-employed or are looking for affordable health insurance for yourself or your family, you should also be cautious of sharing your contact information on out of state websites, as your contact information will be sold and resold to possibly hundreds of agents who will by law be allowed to contact you for the next ninety days and will try to sell you health insurance. 

If you want a safe, confidential resource that you can trust their advice, you can follow this link for and get individual health insurance quotes for affordable health insurance in Dallas Texas.  Once you complete the form, you can review rates and plans from several different insurance carriers, including Blue Cross Blue Shield Texas, United healthcare/Golden Rule, Aetna, Unicare, Humana and many others. 

You will then be contacted solely by an employee of Texas Group Benefits who can help you select the best health insurance plan based on your health and budget.  Be sure to leave a valid email address and phone number and the best time for you to be contacted so that we may assist you.

Texas Group Benefits is dedicated to supporting the needs of our clients.  We know our market, and we know how to provide our clients the best insurance plan designs that meet a range of needs and budgets.  We can help your business provide the employee benefits plans that will serve your business needs and will best meet the needs of your employees.  We are certified as Chartered Benefits Consultants and the training, expertise and experience your business deserves.

We offer consultation and support in addition to group health insurance and group medical plans from a rated companies, group dental insurance, group life insurance, group disability insurance, and voluntary benefits or supplemental benefits.  We can provide our clients Texas small group and fully insured health plans, as well as self funded and partially self-funded medical plans for larger businesses. We also help our clients develop affordable 401K retirement plans with very low administrative costs.

For more information, contact us at 214-764-6315, or (888) 398-6246.