The most affordable health coverage for families and individuals is usually group coverage offered by employers. Larger companies have traditionally been able to offer better plans because of their larger purchasing power. Although employers and groups are not required to do so, most Texas health insurance plans are employer-based or offered as benefits through organizations and associations, including unions, churches and professional membership groups. Employers and groups that make health insurance available to employees and members are not required by law to contribute anything toward plan member premiums, although some insurance carriers mandate that employers pay at least 50% of employee premiums.
Texas health insurance plans offered by small businesses are covered by provisions in state law and differ than those offered by larger employers. Some state-mandated benefits, for example, that must be included in large group plans, are not required to be included in plans from small businesses. A small employer is defined as a business with at least two but no more than 50 eligible employees. A full-time employee who works at least 30 hours a week and is not part of another group plan is considered an eligible employee. Part-time, seasonal and substitute employees are not eligible for small business health insurance.
Large employers may offer different levels of coverage for specific classes of employees, provided all employees within that class, i.e. executives, have access to the same level of coverage. As with small businesses, coverage cannot be withheld from any group because of the health status of any employee in that group. Self-funded Texas health insurance plans are regulated by the U.S. Department of Labor and not subject to individual state insurance laws, including the Texas Department of Insurance. Self-funded ERISA plans can operate in more than one state simultaneously, and are usually more extensive and comprehensive than other group plans.
