Practice Owners: Special Health Insurance Options You May Not Be Aware Of

Life moves fast for small practice owners. Between the responsibilities of running your practice and your family commitments, each day can seem like it never has enough hours in it to get everything done.

So it’s a good bet that in your spare time – what little you have – you’re not poring over the latest iterations of health insurance regulations. Which means you may not be aware of special health insurance options available to you during the small group Special Enrollment Period (11/15 – 12/15, 2021).

Here’s why this matters. With these options:

• Solo practice owners may be eligible for a group PPO plan for themselves and their families - as a "Group of One"
• Small practice owners may be able to offer PPO and HMO health insurance to their employees – and control costs to their practice

The Key to Getting The Coverage You Want

The key to the special health insurance options lies with two little-known waivers to certain Affordable Care Act regulations. The waivers make it possible for small groups and individual business owners to bypass the standard requirements to qualify for a group health insurance plan. The waivers are as follows:

• Participation Waiver – to qualify for group coverage, practice owners don’t have to meet the requirement of having to cover at least 75% of their employees. You only need to make coverage available to your employees.
• Contribution Waiver – practice owners don’t have to pay at least 50% of their employees’ premiums to be able to offer group coverage. Owners can opt to pay what they want or can afford.

For solo practitioners, the waivers may help you qualify for comprehensive group PPO health coverage for yourself and your family – and potentially at a lower cost than comparable individual HMO coverage.

Usually you’ll need to have a tax ID number and one full-time employee besides yourself paid under that number. Partnerships and LLC’s filing as a partnership with no employees may be eligible too. You’ll just need partnership documentation and the company’s Schedule K-1 (Form 1065).

And small practice owners may now be able to offer their employees group PPO coverage because you can contribute what you want or can afford.

You May Have More Options Than You Think

Most physicians prefer PPO over HMO plans because they provide larger networks, coverage for out-of-network services and they don’t require referrals. But individual PPO plans are not available in Texas. So many Texas practice owners may think their only options are HMO or short-term medical plans.

And while short-term plans can offer lower costs, they can be very thin on benefits. They may not provide coverage for maternity, mental health, or any sort of pre-existing condition. In fact, if you or a member of your family suffers from some pre-existing conditions, you could be denied coverage.

Your Window Is Limited

Remember, you have a limited window of opportunity to take advantage of the waivers. Documents must be completed and submitted to the carriers by December 15th to have coverage with an effective date of January 1st, 2022.

Shop Smarter, Speak With An Advisor

Shopping for health insurance options can be time-consuming and complex. But our advisors can provide expert advice and guidance so you can “shop smarter” and make better-informed decisions.

If you’re ready to renew health coverage for yourself or your practice, or wish to get coverage for the first time, call us now and get the coverage you want in place by January 1st. Call toll-free at 1-800-880-8181 Monday to Friday, 7:30 to 5:30 CST.

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.