Southwestern Benefit Designers - Blogs #InsuranceSouthwestern Benefit Designers - Blogs #Insurancehttps://www.swbdmg.com/blogs/tag/insuranceThu, 16 Oct 2025 05:09:40 -0700http://zoho.com/sites/<![CDATA[The Basics of Health Insurance for Small Businesses]]>https://www.swbdmg.com/blogs/post/the-basics-of-health-insurance-for-small-businesses1This post focuses on the importance of tailored small business insurance for the modern digital age. It emphasizes the need for small business owners to grasp the fundamentals of health insurance to provide sufficient coverage and attract skilled employees. Create comprehensive packages with us.]]>

In the dynamic landscape of 2023, providing comprehensive insurance solutions for small businesses has evolved into a pivotal aspect of safeguarding entrepreneurial ventures.

Our offering for small business insurance is tailored to cater to the unique challenges and opportunities that emerging enterprises face in this digital age. As a small business owner, understanding the basics of health insurance is crucial for providing adequate coverage and attracting and retaining a talented workforce. 


But, what are the things you should consider, and when to apply for insurance?


There are four (4) factors that influence small business insurance and how it works. These are Coverage, Number of Employees, Employee Premiums, and Enrollment Period. 


  1. Coverage - The scope of coverage provided by a health insurance plan is a fundamental factor. Different plans offer varying levels of benefits, ranging from basic essential health benefits to more comprehensive packages that encompass a broader range of medical services, prescription drugs, preventive care, and even mental health support. Small businesses must carefully assess their employees' needs and budget constraints to determine the most suitable coverage.

  2. Number of employees - The size of a small business workforce significantly affects the health insurance landscape. The Affordable Care Act (ACA) categorizes small businesses as those with fewer than 50 full-time employees. This classification determines whether a business is required to offer health insurance and the specific regulations it must follow. Businesses with fewer employees might have different options compared to those with larger staff numbers, influencing their choice of insurance plans and the financial implications of coverage.

  3. Employee Premiums - Employee premiums represent the portion of health insurance costs borne by the employees themselves. Many small businesses share the cost with their employees, striking a balance between offering a valuable benefit and managing operational expenses. The amount employees contribute varies based on the chosen plan and coverage level. Communicating these premium contributions transparently is crucial to ensure employees understand the value of the benefit they receive and the financial responsibility they share.

  4. Enrollment Periods - The enrollment period is the window during which employees can sign up for health insurance or make changes to their existing coverage. These periods can be annual, allowing employees to make choices that reflect any changes in their health needs or family circumstances. Timely communication about enrollment periods is vital to ensure employees have access to information and can make informed decisions about their health insurance.


Small business health insurance is a multifaceted landscape influenced by various factors, each playing a crucial role in shaping the coverage options offered to employees. As small business owners navigate these considerations, they should carefully analyze the coverage options available, consider the number of employees covered, evaluate employee premium sharing, and clearly communicate enrollment periods. Collaborating with insurance professionals or brokers can provide invaluable guidance in tailoring health insurance solutions that align with both the needs of the workforce and the business's financial capacity. Ultimately, by understanding and addressing these four influential factors, small businesses can create a comprehensive and competitive health insurance package that supports their employees' health and well-being.


Have a few questions?

Connect with our representatives by completing the form below or you may contact us via the following:


Phone: 972-380-4044

Email: support@swbdmg.com

]]>Wed, 16 Aug 2023 21:30:00 +0000<![CDATA[BCBS TX — MyBlue Health HMO: Using PCPs vs Select PCPs]]>https://www.swbdmg.com/blogs/post/bcbs-tx-—-myblue-health-hmo-using-pcps-vs-select-pcps

MyBlue Health HMO: Overview

  • In January 2020, Standard Products launched the Texas high performance network in the Dallas and Harris Markets to establish a competitive product aimed to deliver value and offer a competitiaaaave offering for subsidized market providing access to high quality care at an affordable price.

  • While the MyBlue Health network is mirrored after the Blue Advantage HMO product, Blue Advantage HMO and Blue Advantage Plus are different products that do not have relation/combination with MyBlue Health.

  • A consumer not located in the zip codes where MyBlue Health is available, will not have the ability to enroll in the product.
  • A key feature of the MyBlue Health HMO is the Sanitas Medical Group collaboration model.

MyBlue Health HMO: Sanitas Benefits

  • All BCBSTX members (all lines of business) can utilize Sanitas Medical Group professionals and Sanitas Medical Centers but only MyBlue Health HMO members who selected a Sanitas PCP have a $0 PCP cost share when at a scheduled PCP visit with their Sanitas PCP

  • MyBlue Health HMO members don't have to use Sanitas PCPs; if they don't, they're encouraged to stay in network on their MyBlue Health HMO plan and would pay applicable cost shares

    • The Sanitas $0 PCP benefit is only for members who:

    1. live in Dallas or Harris county

    2. select a MyBlue Health HMO policy in the Retail ACA QHP market (on & off exchange)

    3. choose a PCP from the Sanitas Medical Group

  • General plan benefits apply to services excluded from or not listed as included at $0
  • General plan benefits apply to all services provided outside of Sanitas Medical Group, even if referred from a Santas PCP

Select PCP Practice Groups

Bexar County:

CentroMed


Dallas County:

Sanitas Medical Centers


Harris County:

Sanitas Medical Centers


Travis County:

CommUnityCare

Lone Star Circle of Care


Williamson County:

CommUnityCare

Lone Star Circle of Care

Select PCP Practice Groups for Expansion Counties

Cameron County:

Su Clinica Familiar

Harlingen Physician Network

BHS Physicians Network (dba Baptist Medical Network)


Collin/Denton/Tarrant County:

VMO Primary Providers N TX PLLC


El Paso County:

Centro De Salud Familiar La Fe Inc

Project Vida Health Center


Hidalgo County:

South Texas Health System Clinics


*other independent community physicians may be eligible to serve as a Select PCP

]]>Mon, 24 Oct 2022 13:18:40 +0000<![CDATA[ Case Study: M Company]]>https://www.swbdmg.com/blogs/post/allstate-initial-quote-pre-underwriting-vs-final-pricing-after-u-w-produced-a-7.8-lower-final-price

Allstate initial quote (pre-underwriting) vs final pricing after u/w produced a 7.8% lower final price

By David Rubey, Sr. Advisor -- Group & Individual Health, Life, and Disability

After u/w we typically see pricing lower than the initial quote. Therefore, to accurately show premium differences/savings it is best to get employees to complete the medical questions up-front.   However, we know that is not always realistic, so Allstate will provide an illustrative quote on census data. 


NOTE; this group has a recent newborn with ongoing potential medical bills, along with some other employees with claims, i.e. it is not some perfect / no-claims, best possible case scenario, and they still received lower premium rates after underwriting. 


Comparison of premium of the Fully Insured Guarantee Issue renewal plan. This is also lowest premium of all major FI / GI carrier quotes.


                                                                HMO plan with $3,500 deductible                          Allstate PPO w/ National PPO                   Renewal % higher than Allstate

Employee Only:                                                         $503.09                                                          $347.07                                                           45%

Employee + Spouse:                                               $1,006.18                                                      $832.93                                                            21%   

Employee + Child(ren):                                           $1,006.18                                                      $659.42                                                            53%

Employee + Family:                                                 $1,509.27                                                      $1,110.58                                                        36%


 


Comparing to PPO rates so as to be closer to Apples to Apples price comparison

Current carrier PPO Plan Option:

EE Only:                                                                       $564.75                                                                         63%

EE + S:                                                                          $1,129.50                                                                      37%

EE + C:                                                                          $1,129.50                                                                      71%

EE + F:                                                                          $1,694.75                                                                       53%

* Both renewal and Allstate plans have a $3,500 deductible.   Renewal max out-of-pocket is $7,900 while Allstate's is $8,550. 

 

Most employee of this group have Family coverage.  Based on current enrollment this group will save over 35% with a well recognized national PPO network vs renewal with an HMO network.  If comparing to PPO network pricing, the cost saving would exceed 50%.  Since this group now has employees in other states, a national PPO network is important to them.


The Allstate plan is also on a level premium funded participating contract.  This simply means that approx. 6 months after the plan year end, Allstate will compare claim dollars spent vs claim fund dollars.  If there is a positive balance, 50% of the balance will be paid back to “M” company.  If there is a negative balance, “M” company will not pay any more than the initial premium already paid. 


Seeing a nearly 8% pricing difference in the quote after medical questionnaires were completed shows the importance of getting these done up front when possible.  After the full underwriting is done, there is still  ZERO obligation to use Allstate.  However, with most of our clients, the potential to save 25%, 30%, even 50%+ is motivation enough for employees to complete the questionnaires. This is especially true when the employees are sharing in the cost of the insurance. In looking at the EE + Family cost, presuming the company pays 50% of employee only price and $0 towards spouse/child premium costs, the employees are looking at saving, approximately $485/mo or roughly $5,800 per year out of their pocket (or added to their bring home pay).  That is effectively a SIGNIFICANT pay increase for the employee, while on this group of 10 employees, it is also SAVING the company over $18,500 per year in their costs, with potential to save even more in good claim years. 

With this type of saving, employers can offer more benefits to better compete with larger employers, like group life, AND employees will have more money to have for other ancillary lines of coverage like voluntary life, dental, vision, Accident Medical/GAP coverage, etc.  similar to what many larger employers are offering in an effort to attract and retain top level employees. 
]]>Tue, 11 Oct 2022 13:02:00 +0000