Austin Texas low cost group health insurance policies and plans

Group Health Insurance Austin, Texas

Texas Department of Insurance

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With insurance plans changing all the time and costs increasing constantly, getting the coverage you need at affordable rates can be a real challenge. We the guesswork out of insurance shopping by giving you FREE quotes from top health insurance companies in just minutes.

We make it easy to find great health coverage at the lowest rates available anywhere. Simply fill out one of our short request forms and in just minutes, you'll receive several quote comparisons from top-rated companies. Start your FREE quote now!

Top companies represented in our network include:

Aetna, BlueCross BlueShield, Blue Cross and Blue Shield, Assurant Health, Time Insurance and over 100 others.

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How our Rates are Established

Texas law requires all fully insured small employer health benefit plans to small employers to comply with specific rating requirements to improve the affordability and availability of health coverage for small employers, . Those requirements do not apply to "self-insured" or "self-funded" health plans. The law establishes certain limits and guidelines that carriers must use when calculating rates for small employers although the Texas Department of Insurance (TDI) does not approve or set health coverage rates.

Below is a simplified explanation of the criteria affecting rates.

Texas law allows insurance carriers to use the following

Five case characteristics in determining a group´s rate:

•age of employees

•size of the small employer group

•gender of employees

•geographic area.

•industry classification

Age

The older your employees are, the more you can expect to pay for health insurance. Older employees can reasonably be expected to have more, and often more expensive, health-related claims. Statistics show that, in general, an individual is more likely to use health care services as he or she ages.

Group Size

As the group size increases, the per-insured expenses required to issue and service the business decrease allowing for a lower rate

When purchasing medical coverage, small groups tend to select insurers based on the insurance needs of each employee in a small group. As group size increases, this selection becomes more difficult and is spread over a larger base.

Gender

Females generally incur greater medical costs than males at younger ages, especially during her childbearing years. In their late fifties or early sixties the variances in costs diminish with age until medical costs for males begin to exceed those for females.

Geographic Area

The cost of medical care varies from one area of Texas to another due to the general cost level of the area, the differences in medical practices by each region, the degree of specialization of services, and the amount of competition. Most small group plans vary rates either by ZIP code. or county. The employer´s business address is generally used to determine rates.

Industry

People working in some industries exhibit higher medical claim costs than in others. This is due in part to prevalence of accidents and the working conditions Additionally, higher employee turnover in some industries may result in higher administrative costs for the insurer.

The rate factor associated with an industry classification may not exceed the lowest factor associated with an industry classification by more than 15%.

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Health Benefit Plan Characteristics

Health plans are now classified as either "consumer choice health benefit plans." or "state-mandated health benefit plans" A consumer choice health benefit plan is any plan developed by a carrier that is required by law to include only a very few state-required benefits. A state-mandated plan provides certain required minimum features and coverages.

Although consumer choice health benefit plans also may be called "standard plans," the term should not be interpreted to mean that the coverages provided are "standardized." Every insusrance carrier´s consumer choice health benefit plan may be different - and, in fact, a carrier may offer several different consumer choice health benefit plans.

Some state-mandated benefits continue to be required for consumer choice health benefit plans, including coverages for

complications of pregnancy

minimum hospital stay after childbirth (federally mandated)

phenyltketonuria treatment, if prescription drugs are covered

mastectomies (federally mandated).

Unlike insurance companies, HMO consumer choice health benefit plans must include basic health care services, such as inpatient, outpatient, and preventative services. Carriers may offer optional benefits that vary widely from insurance plan to plan.

The rate guide contains rate information on the following types of plans:

•

a carrier´s most popular indemnity consumer choice health benefit plan

a carrier´s most popular PPO consumer choice health benefit plan

•

a carrier´s most popular preferred provider organization (PPO) state-mandated health benefit plan

•

an HMO´s most popular consumer choice health benefit plan.

an HMO´s most popular state-mandated health benefit plan

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PPO plans have 2 levels of benefits. The plan will reimburse at a higher level of benefits when an employee uses a network provider. The plan will ray less when an "out of network" provider is used.

An indemnity plan gives the employee the freedom of choice to use any provider you want. When services are received, the employee usually pays the provider and then submits a claim form to the carrier. The plan will require that the employee satisfy the deductible before it will reimburse.

Health insurance carriers do not have to offer both PPO and indemnity plans howevers ome carriers may offer both types of plans.

Generally, HMOs require employees to receive services from providers in their network. Although, the HMO must pay for out of network services only when those services are not available from network providers, the HMO might not pay for the treatment.if an employee obtains services from an out of-network provider without prior authorization.

Purchasing Coverage

Texas state law requires small employer carriers to provide premium quotes to small employers (directly or through an authorized agent) within ten working days of receiving a request for a quote and the information necessary to calculate the premium. If an insurance carrier needs more information to develop the quote, it must request it within 5 days after receiving the request. A small employer health insurance carrier may not decline to provide a quote to a small employer directly or through an authorized agent - There are no exceptions.

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News from the Blues... for Employers

May 6, 2011

FDA to Remove Unapproved Prescription Cough, Cold and Allergy Products from Market

The U.S. Food and Drug Administration (FDA) recently announced that it intends to remove certain unapproved prescription cough, cold and allergy drug products from the U.S. market. Many of these are older products and have never been fully evaluated by the FDA for safety, effectiveness and quality. People may be at greater risk when using these products than when using FDA-approved prescription drugs or drugs that are appropriately marketed over-the-counter (OTC).

Manufacturers will be required to cease production of these unapproved medications within 90 days and distribution to the market within 180 days. During May we will evaluate current utilization of these products and the need to notify members if there is a significant number of members still using the unapproved products. We anticipate that utilization will be significantly reduced since manufacturers are discontinuing production of these products and pharmacies will be converting members to approved products.

For more information and a list of unapproved cough, cold and allergy products, please visit the FDA’s website: fda.gov/ForConsumers/ConsumerUpdates/ucm244852.htm

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April 22, 2011

Legislative Update

Obama signs bill to repeal voucher program

President Barack Obama has signed into law a bill that repeals a provision of the health care reform law, the Affordable Care Act, which would have required employers to offer low-wage employees company-paid vouchers to buy coverage in state health insurance exchanges.

As we reported last Friday, the repeal was included as part of H.R. 1473, the bipartisan budget agreement that provides funding for the federal government to operate for the rest of fiscal year 2011.

DOL reports on essential health benefits

The U.S. Department of Labor (DOL) released a report to the U.S. Department of Health and Human Services (HHS) last Friday on its analysis of the medical benefits most commonly covered under employer-sponsored benefit plans. The Affordable Care Act requires that essential health benefits be equal in scope to the benefits under a typical employer plan.

The DOL report, along with a report from the Institute of Medicine due in September, will provide information to HHS to assist in setting regulations on essential health benefits.

The report, which pulled existing data from the DOL’s National Compensation Survey, listed 12 additional medical benefits typically offered beyond the general hospital and physician office visits. They include:

emergency room visits

ambulance services

diabetes care management

kidney dialysis

physical therapy

durable medical equipment

prosthetics

maternity care

infertility treatment

sterilization

gynecological exams and services

organ and tissue transplantation

The findings include information on how often employers cover or exclude such benefits and the type of limits imposed on them. The full report can be found at bls.gov/ncs/ebs/sp/selmedbensreport.pdf.

The release of the report does not require any action by employers or make any changes to the current assumptions Blue Cross and Blue Shield of Texas (BCBSTX) has made regarding what we consider to be essential health benefits. HHS Secretary Kathleen Sebelius has said that they will consider this report as they develop their regulations for essential health benefits. Sebelius also announced that this fall HHS will launch an effort to collect public comments on this issue.

CMS database to monitor state exchanges

The Centers for Medicare and Medicaid Services (CMS) announced last Friday that it plans to develop a Health Insurance Assistance Database as part of a program to oversee states' development and operation of health insurance exchanges. The CMS Center for Consumer Information and Insurance Oversight will build the database, which will collect information on consumer inquiries and complaints regarding the exchanges.

Authorized under the Affordable Care Act, exchanges are Web portals enabling consumers and small businesses to compare and purchase coverage starting in 2014.

Quick ruling on ACA’s constitutionality not likely

The Supreme Court justices are scheduled to consider a request today by the Commonwealth of Virginia seeking to bypass the normal appeals process for a quicker ruling on the constitutionality of the Affordable Care Act. Analysts say such requests are rarely granted, and that the Supreme Court would likely allow the law to be considered first by the appeals court under the usual process. With that process, any Supreme Court review of the law would be put off until its 2011-12 term, which begins in October, depending on how fast the appeals courts rule.

Activities such as these continue among the states. In Idaho, Governor C.L. “Butch” Otter issued an executive order Wednesday imposing a state prohibition on receiving federal funding for or otherwise implementing the Affordable Care Act. The executive order directs state agencies not to establish new programs, promulgate rules or accept federal funding to implement the Affordable Care Act. It also bars state agencies from assisting federal agencies in implementing the law.

However, the executive order does allow the Idaho Departments of Insurance and Health and Welfare to continue developing a state health insurance exchange. The governor said that would prevent the federal government from controlling the state’s insurance market by administering an exchange of its own in Idaho.

BCBSTX continues to focus on keeping you informed and to assist you in navigating health care reform and other legislation impacting your benefit plans. We always welcome your feedback on how we can improve this effort. Please contact your BCBSTX account representative with any suggestions, concerns and questions you may have.

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February 26, 2011

This Week in Health Reform

Your business is affected daily by legislative activities on Capitol Hill – and those activities change minute by minute. Today we want to give you a brief update on two happenings this week of particular interest for businesses providing health benefits coverage for employees.

White House Health Care Reform Summit

On Monday, Feb. 22, President Barack Obama released an 11-page, $950 billion health care reform proposal, ahead of Thursday’s highly anticipated bipartisan health care reform summit. While the president’s proposal only included a set of policy priorities, not legislative language, its principles are similar to the Senate-passed health care reform legislation.

Congressional and committee leaders from both parties participated in a day-long Health Care Reform Summit, on Thursday, Feb. 25, along with other members designated by their party’s leadership. The summit was both cordial, as well as contentious, with Congressional leaders oftentimes arguing over their fundamental differences and beliefs.

President Obama, who moderated the summit, wrapped up the day-long discussion on health care reform by telling Republicans to find common ground with Democrats in the upcoming weeks, or that Democrats will “go ahead and make some decisions,” likely meaning that the Democrats will pass the current health care reform legislation through the budget reconciliation process. Many Republicans stated during the summit that they want to scrap the current health care reform bills and start over, taking a more incremental approach.

It remains to be seen how both political parties will proceed in the coming weeks.

Extended Subsidy Eligibility Period Expires Sunday Unless Congress Acts Again

The extended two-month eligibility period for the premium subsidy program is set to end this Sunday, Feb. 28, 2010. This means that workers involuntarily terminated starting March 1 will not be eligible to receive the 65 percent premium reduction of COBRA or state continuation benefits.

Many believe there is Congressional support for extending the premium subsidy eligibility period again, and expect consideration of the issue in coming weeks.

Our hope is that any extension will be passed before the eligibility period ends this Sunday, to avoid another retroactive benefits period. As of this morning, the House has passed a voice vote to extend the subsidy by one month. It now goes to the Senate, but isn’t expected to pass before week’s end.

Either way, we will endeavor to keep you informed as changes occur. The premium subsidy implementation workgroup will quickly evaluate any new requirements and address the operational processes necessary for compliance, should any further extension be approved.

A Division of Health Care Service Corporation, a Mutual Legal Reserve Company,

an Independent Licensee of the Blue Cross and Blue Shield Association.

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Group Health insurance Austin, Texas

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