Emma and Lisa run a Montessori school in Fort Worth. Their teachers work hard every day, and they want to offer them health insurance as a benefit. They know that having good benefits can help them keep their best teachers and attract new ones. The problem is that health insurance coverage is expensive, and they need to keep their costs under control.
When they start looking into traditional group health insurance, they find out that health insurance companies have rules about how many full-time employees need to sign up. If not enough people enroll, they might not qualify for coverage or could end up paying higher monthly premiums.
This is something they had not thought about before, but now it is something they need to figure out. They reached out to Insurance For Texans to learn more about participation rates and how they affect their school’s ability to get affordable health insurance.
At first, Emma and Lisa assume that every teacher and staff member at their Montessori school has to sign up for the plan. After a quick explanation, they realize that is not exactly how it works. Most insurance companies require a certain percentage of eligible employees to enroll in the plan. This is known as the minimum participation requirement and can change depending upon the full-time equivalent employees your business has at the time of enrollment.
What surprises them is that some employees do not count toward that number. If someone already has health insurance benefits through a spouse or another job, they are not included in the participation requirement.
Emma and Lisa go back and look at their staff. Several of their teachers have coverage elsewhere, which means they do not have to count them when calculating the participation requirements. This makes their lives a bit easier. Now that they understand how participation works, they start to wonder how it affects the monthly cost of the plan.
Emma and Lisa quickly learn that participation rates do not just determine whether they qualify for a plan. They also play a big role in how much they will pay in health insurance costs.
Insurance companies like to spread risk across many employees. When more people enroll, it spreads the risk across more people for the health insurer. That helps keep annual premiums more affordable. When only a small handful of people sign up, the insurance company sees the plan as riskier and may raise the health insurance premiums or offer fewer coverage options.
Emma and Lisa realize that if they could encourage more teachers to join the plan, they could get better monthly premiums and access to stronger essential health benefits. This is a big deal for their school because it means they can offer better coverage to employees without breaking their budget.
They now have a plan to get more employees involved, but then they hear about something that could make their decision even easier.
Emma and Lisa learn that some insurance companies offer a special time each year when participation requirements are not enforced. If they enroll during this period, they can get a traditional group plan with less requirements and better terms.
This gives them more flexibility and is a huge relief. They no longer feel pressured to convince a certain number of employees to sign up for health coverage right away.
By leveraging the special enrollment period, they can focus on getting the best health insurance plan in place and helping their teachers understand why it is the best health insurance option for all of them. The next step is making sure their staff knows the value of the health plan and why it is worth signing up.
Emma and Lisa realize that if their teachers do not understand how the health plan works, they may decide not to enroll. Some of them may think it is too expensive or believe they do not need it. Others may not know how it compares to health care coverage available on individual plans.
They were glad that they decide to work with an experienced Texas health insurance broker who can explain the health insurance benefits to their employees. Having an expert answer questions and clear up any confusion will help more people feel confident about signing up. The more employees who enroll, the better the school’s chances of keeping health care costs low and offering a strong benefits package.
In the end, they feel good about their decision and were glad that they worked with a health care broker who could easily explain how business health insurance works. They now have a great employer sponsored plan that fits their budget while giving their teachers access to great health coverage.
If you are a small business owner in Texas and need help finding the right health plan, click the button below to connect with an experienced broker. You do not have to figure this out alone.