Category Archives: Group Insurance

Dental Insurance Mandate

Many people underestimate the importance of good oral health. The reality is that it is so vital that the new Health Insurance Policies under the Affordable Care Act are required to provide Pediatric Dental as anEssential Health Benefit. In 2008 over 4 million children did not obtain needed dental care simply because they couldn’t afford treatment. The top 5 reasons for maintaining good oral health are:

1. To prevent oral cancer, curable if diagnosed early

2. To prevent gum disease

3. To maintain overall good physical health, heart attacks can result from poor oral hygiene

4. To keep your teeth!

5. Have a white bright smile and prevent bad breath

Often affordability is one of the biggest factors for people not getting the dental care they need. Fortunately there is a solution. With many companies now offering affordable, comprehensive Dental Insurance to Individuals. In years past, most people could only obtain good dental benefits through a Group plan. We now have multiple plans available, with innovative benefits, such as a Dental, Vision, and Hearing plan, at a price to fit any budget. Please give us a call at 877-740-8683, or visit today for a free quote.


Health Insurance Open Enrollment Ends in Texas

The 2014 Open Enrollment Period for Individual Health Insurance has ended. You may still be able to obtain Health Insurance, if you have a Qualifying Life Event, or Special Circumstances, that would provide you a Special Enrollment Period.  Qualifying Life Events can include such things as loss of Group Coverage, birth, marriage and divorce. Please give us a call at 877-740-8683, or visit , to find out if you qualify. There are deadlines for each circumstance, so please don’t delay. Since there are so many rules in the new Marketplace, you need the help of an experienced Agent, now more than ever. Don’t go it alone.

Texas 2014 Small Group Definition

There is a new definition for a small employer for 2014.   This “small” change will affect a lot of people.

Today, a “small” employer is one who employed an average of at least one but not more than 50 employees during the prior calendar year, and who employs at least one employee on the first day of the plan year.

Employees are defined as individuals employed by an employer and include full-time, part-time, temporary and/or seasonal employees.

Before 2014, the “size of a group” was determined by eligible employees.  This number came from how many people were full-time (and had satisfied their waiting period), or were COBRA eligible.   Out of those that were eligible you could deduct the people that had a legitimate waiver.  This could be a person who was covered by their spouse’s insurance, or some companies allowed individual coverage to constitute a legitimate waiver.

As a small employer you must also meet a minimum participation to qualify for group insurance coverage.  You have to have at least 50% participation in the insurance.
For example:
In 2014 – if you have 20 employees – 10 must participate.
Before 2014 – if you had 20 employees and 10 were part-time or seasonal, you only needed 50% participation of the remaining 10 which would be 5.

Doesn’t sound so bad right?  Well here is the kicker.

The small employer has to pay at least 50% of the employee only premium.  So instead of paying 50% of 5 people (in 2013) … he now has to pay 50% of 10 people (in 2014).

Not to mention, as long as the group is under 50 total employees in 2014 the rates are community rated (not based on health).  However, once it goes over 50, it goes thru medical underwriting.

This will be the reason why you see more employers laying off people to either stay under that 50 employee mark – you will see them lay off part-time workers because maybe they can’t afford to pay insurance for a part-time employee – or you will see employers possibly not hiring a “visibly” sick or older person because unfortunately they will be more costly on their insurance.

We do not agree or disagree with what is going to happen, we are merely trying to outline the changes and shed some light on what is coming in our near futures because of the “change” in healthcare.

Obamacare Premiums to Soar in Most States

As we anticipated … we are now hearing from the media how much Obamacare premiums will be, and who is really going to pay.  Read the post below on CNNMoney for more information.

CNNMoney.comBy Tami Luhby | – Tue, Aug 6, 2013 5:57 AM EDTA Tea Party member reaches for a pamphlet titled "The Impact of Obamacare", at a "Food for Free Minds Tea Party Rally" in Littleton, New Hampshire in this October 27, 2012 file photo. REUTERS/Jessica Rinaldi//Files

Reuters – A Tea Party member reaches for a pamphlet titled “The Impact of Obamacare”, at a “Food for Free Minds Tea Party Rally” in Littleton, New Hampshire in this October 27, 2012 file photo. REUTERS/Jessica …more 

Get ready to shell out more money for individual health insurance under Obamacare … in some states, that is.

While many residents in New York and California may see sizable decreases in their premiums, Americans in many places could face significant increases if they buy insurance through state-based exchanges next year.

That’s because these people live in states where insurers were allowed to sell bare-bones plans and exclude the sick, which has kept costs down. Under Obamacare, insurers must offer a package of essential benefits — including maternity, mental health and medications — and must cover all who apply. But more comprehensive coverage may lead to more expensive insurance plans.

Under Obamacare, all Americans must have insurance coverage starting in 2014 or face penalties of $95 or 1% of family income, whichever is greater. Enrollment in the exchanges begins October 1, with coverage kicking in in January. Plans will come in four tiers, ranging from bronze to platinum.

Some lightly regulated states, including Indiana, Ohio, Florida and South Carolina, have recently released preliminary rate information highlighting steep price increases. Unlike the blue states of California and New York, these are Republican-led states that have strongly opposed the Affordable Care Act, as Obamacare is officially known.

Comparing this year’s and next year’s plans isn’t easy because the structure of the plans is so different. Each state comes up with its own method.

Behind the numbers in 3 key states. In Florida, for instance, officials constructed a hypothetical silver-level plan based on the offerings available today. Then they looked at how the cost of that plan compares to the average silver plan that will be available on the exchange. Florida found premiums will rise between 7.6% and 58.8%, depending on the insurer. The average increase would be 35%.

The main driver of the premium increases is the Obamacare mandate that coverage be offered to everyone, said Kevin McCarty, Florida’s insurance commissioner. There are just short of a million enrollees in the individual market in Florida, while 3.8 million are uninsured. The state does not allow new entrants into a “high-risk pool,” which provides coverage to the sick.

“People who are in their 50s with high blood pressure have no coverage options,” he said.

Ohio, meanwhile, said there would be an average increase of 41% by comparing a trade association’s report of premiums for all plans available today with the average premium expected on the exchange.

Indiana officials said prices would rise an average of 72%. But they were looking at the cost of providing care, not actual premiums.

All of these rate hikes must still be reviewed by the federal government and do not take into account the fact that Americans with incomes up to $45,960 for an individual and $94,200 for a family of four will be eligible for federal subsidies.

So why aren’t there such big premium increases in other states? New York, for example, already required that insurers provide comprehensive coverage to all who apply. Rates there could fall by half since the pool will expand to include many younger, healthier residents under Obamacare. But New York is more the exception than the rule, experts said.

Rate hikes depend on age and gender. To give consumers a better idea of how premiums will change, CNNMoney took a look at the plans provided by one insurer: Physicians Health Plan of Northern Indiana.

Our analysis found that 21-year-old men will pay a lot more for an exchange plan, but 42-year-old women and 62-year-old men will shell out less for a silver-level plan that comes with a $2,500 deductible and a roughly $25 co-pay for office visits.

Under this scenario, a young man’s monthly rate will rise to $214 on the exchange next year, up 63% from today. The woman, however, will pay $284, a drop of more than 7%, while the older man will be charged $615, a nearly 6% decrease. This is because Obamacare requires that women pay the same amount as men and does not allow insurers to charge older participants more than three times the young.

Physicians Health expects most enrollees to sign up for bronze or silver plans, which have lower monthly premiums but carry higher deductibles and co-pays, according to Jim Brunnemer, the insurer’s chief financial officer. Today, its members typically buy high deductible plans.

While premiums may go up in these states, Obamacare advocates say people will receive more comprehensive coverage. Also, the law limits the amount people have to pay out-of-pocket for deductibles and co-pays to $6,350 in 2014.

“A lot of people will get more for their money,” said Sarah Lueck, senior policy analyst for the Center on Budget and Policy Priorities. “Even people paying a higher rate will benefit. It will be a big change in most states.”

View this article on CNNMoney


As always, we will be your source for the Open Enrollment beginning October 1, 2013.  Give us a call or visit our website for quotes and to determine if you qualify for a subsidy, how much and how to apply.
Toll Free 877-740-8683

“Hassle Free” Insurance Application Process

We recently had a couple of experiences that reminded me just how important it is to the consumer to make the Insurance Application process as easy as possible. We had a returning Medicare Supplement customer that has trouble hearing on the phone. By completing most of the process by email, and making sure the Insurance Company understood the situation, we were able to complete the final voice signature in just a few minutes. Another Individual Health Insurance customer visited our website after being referred by a co-worker for Dependent Coverage options. She said the person that referred her to our company had really appreciated the fact that we were able to answer their questions, and help them find the right plan, by email. Then the final stage to complete the application was done in only a few minutes by phone. Whether you find it difficult to communicate by phone, or just don’t have the time, we can find a way to help. With most of our carriers, we are able to complete your application with a voice signature, or an e-signature by email, so we virtually eliminate paperwork. We always do our best to make sure your Insurance purchase is a ” No Hassle” experience. To speak to a licensed insurance agent, just call 877-740-8683, or visit .