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Protecting What Matters Most


Open Enrollment Brings Opportunities For PPO Health Insurance



Whether you’re looking for your own health insurance, or wish to offer coverage to your employees, it’s easy to appreciate the benefits of PPO health insurance.

Larger networks of physicians and hospitals, fewer restrictions, and more comprehensive benefits make PPO health insurance a desirable option for many people.

For some physicians, however, PPO health insurance may not seem feasible. If you are looking for your own plan, you’ll see that individual PPO health insurance is difficult to find in Texas. And If you are a small practice owner it may seem too costly to offer to your employees.

This is why now, during Open Enrollment, you may want to speak with a health insurance specialist. What they can tell you about PPO health insurance may surprise you.

Open Enrollment Offers Opportunities

TMA Insurance Trust advisors are health insurance specialists. They have years of experience helping Texas physicians get the best possible coverage at a cost that works for them. As such, they are well versed in the dynamics and complexities of today’s health insurance landscape.

In recent years they have been advising independent practice owners about an opportunity that is available during Open Enrollment. It involves special waivers to the criteria a practice generally needs to meet to qualify for group health insurance.

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800-880-8181 7:30 – 5:30 CST Monday – Friday

How The Waivers Work

Usually, to qualify as a group, 75% of eligible uninsured employees are needed to participate in a health insurance plan. In addition, a practice would need to contribute 50% of the premium for each participant.

During Open Enrollment, there may be situations where some practices could be eligible for waivers to these requirements.

Group PPO Health Insurance For New Groups

If you are establishing a new group health plan, or you are interested in changing your group to a new insurance carrier, you may be able to utilize a waiver to the Contribution Requirement.

This could allow your practice to adjust the percentage that you contribute toward your employees’ cost of a group plan. So, for example, a practice with a smaller budget may be able to take advantage of the Contribution Waiver to make it financially feasible for them to offer a group plan to their employees.

A Group Plan Can Benefit Employees

Typically, participants in a group plan can obtain better coverage at a lower cost than if they purchased their own individual coverage.

By joining your group PPO health insurance plan your employees could get a broader range of benefits at a lower cost than with a plan they might purchase individually.

Get Group PPO Health Insurance For Yourself And Family

The waivers could also help practice owners qualify for group PPO health insurance for just themselves and their family. That’s because during Open Enrollment there would be a waiver to the Participation Requirement – so you would not need 75% of your employees to participate in a group plan.

If you have a tax ID number and at least one employee besides yourself, you may be able to get a group PPO health insurance plan for just you and your family.

Note, you would have to make the coverage available to your employees. But even if none of your employees take the coverage, you can still enroll in the group PPO plan as a "group of one."

This may also be the case for partners and LLC owners filing as a partnership with no employees. To qualify, you will need to provide partnership documentation or your company’s Schedule K-1 (Form 1065).

Service And Support Also Bring Savings

In addition to advising you about the waivers, our health insurance specialists can help you with many of the administrative tasks that come with maintaining a group health insurance plan.

They can enroll your staff and their dependents in your plan, ensure participants receive temporary ID cards and coverage information, and help with customer service and claim issues throughout the year.

And this personalized service comes with no additional cost to your practice.

Call While There’s Still Time

If you would like to explore your options for getting group PPO health insurance – either for yourself or your practice, please reach out to us today.

Call today, because Open Enrollment will end soon. And to take advantage of the waivers your paperwork must be finalized by December 13th, 2019.

Our advisors can be reached toll-free at 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.

Speak with a TMA Insurance Trust Advisor:

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