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Protecting What Matters Most


Health Insurance Open Enrollment: Ways For Practice Owners To Control Costs

Practice owners who are shopping for health insurance during Open Enrollment, between November 1st and December 15th, can consider ways to control the cost of their health insurance. Some may think that increasing the deductible – the amount each employee would need to pay before the insurance company begins to pay benefits – is the way to offset a premium increase. However, it may be worth considering another way to manage costs so benefits can be maintained or made more affordable to the practice.

Controlling Direct Costs

We want to inform about a lesser-known option practice owners can employ to keep the cost of their health insurance within budget. This entails taking advantage of special waivers to the criteria a practice needs to meet to qualify for group health insurance. Usually, to qualify as a group, 75% of eligible uninsured employees need to participate and the practice needs to contribute 50% of the premium for each participant. During Open Enrollment, these criteria will not need to be met to qualify for a group plan.

These waivers can be used by practices to achieve different goals:

  • Getting Group PPO Coverage For Yourself and Your Family – Most physicians want the flexibility of a PPO plan; however, individual plans are not available in Texas. Owners of a practice with a tax ID number and at least one employee (besides themselves) may be able to qualify for a group PPO plan for themselves and their families. They would have to make the coverage available to their employees, but owners would not be required to contribute toward their premiums.

    Partners and LLCs filing as a partnership with no employees may also be eligible for group coverage for themselves and their families. To qualify, a physician needs to provide partnership documentation or the company’s Schedule K-1 (Form 1065).
  • Offering a Group Plan to Employees – Practices with smaller budgets can use the waivers to offer group coverage to their employees. Instead of everyone in a practice buying their own individual insurance plan, the waivers make it possible to offer group coverage to employees. Participants can typically obtain better coverage at a lower cost than if they purchased coverage individually.

    If you are establishing a new group health plan, or interested in changing your group to a new insurance carrier, you may be able to utilize the Contribution Requirement Waiver. This would allow your practice to adjust the percentage you contribute towards the employee cost, which will help maintain better coverage for all plan participants.
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Controlling Indirect Costs

There is another cost that comes with a group health insurance plan. This is the cost associated with the time you and your staff spend on administering the plan - time spent enrolling the staff and their dependents, making sure participants receive temporary ID cards and coverage information, dealing with staff updates and changes during the year and billing, customer service and claim issues. That’s time away from treating patients and running the practice. TMA Insurance Trust advises that a professional agent supports a practice best by relieving medical practices from much of the administrative burden.

To find out more about these limited-time waivers and group benefit options, TMA Insurance Trust advisors can be contacted toll free 1-800-880-8181 Monday to Friday, 7:30 to 5:30 CST.

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For over 60 years, TMA Insurance Trust advisors have been serving Texas physicians, their families and staff. TMA Insurance Trust prides itself on offering unbiased information and strategies to members, along with exclusive group rates on a range of the highest-rated plans in the industry.

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