Group Health Insurance for Houston, TX

2 to 50 Lives Small Group Reform:

This product is based on the guidelines given to the insurance companies by the state of Texas which mandate basic benefits, offer voluntary enhancements at an increased price, and give underwriting guidelines for the initial and renewal rates.

Employees and dependents can not be turned down for coverage regardless of health status, but prevailing base rates of the insurance company can be loaded according to the risk evaluation. The amount of load on the base rate can vary from 0% to 67%.

There are very few industries that are ineligible for coverage, but some risk load may be applied to a group because of a specific industry. All insurance companies do not consider the individual industries risk the same which makes it easier to compete when the group is marketed. How the insurance company considers the impact of the mandated benefits has a direct effect on their particular rating structure.

50 to 100 Lives:s

The risk evaluation for this size of group is based partially on the experience, claims versus premium, and the manual rates. Predictability of losses is given some credence in developing the rate structure for some of these groups. Because of the underwriting structure for 50 to 100 lives, groups can be denied coverage due to poor risk assessment, or rates can be loaded to a satisfactory level to assume a particular risk. Some benefits are mandated by the state to be included in the contracts, but significant latitude can be utilized in developing alternative quotes.

100 Lives Plus:

These plans are underwritten based more on experience as the size increases. Some insurers differ in their minimums but as group prospects grow in employee population many times an insured will be willing to self insure and self fund some of the risk that would ordinarily be taken completely by the insurance company. Because of the greater risk-sharing, more latitude is given to what benefits must be included in the contracts and which ones are optional. This can have a significant impact on the rating structure of a potential client.