1 to 10 employees
Even a one-person business with the owner on payroll qualifies for a small-group plan. Many solo entrepreneurs use this to get better rates and richer benefits than individual coverage.
QualifiesTexas small-group health insurance has clear rules on who qualifies, what carriers must offer, and how the plan is set up. If you employ 1 to 50 people, the ACA guarantees you access to a group plan. Here is what you actually need to know.
Texas follows the federal ACA definition. If your business has 1 to 50 full-time-equivalent employees, you are in the small-group market. That includes the owner if they take a W-2 salary, and it counts part-time workers by adding up their hours. Above 50, you move into the large-group market, which follows different rules and rates.
Even a one-person business with the owner on payroll qualifies for a small-group plan. Many solo entrepreneurs use this to get better rates and richer benefits than individual coverage.
QualifiesMid-size teams get the same guaranteed-issue protections. Carriers must offer coverage, and they cannot raise rates because of anyone's health history.
QualifiesAt the upper end, you still benefit from community rating and ACA protections. Once you cross 51 FTEs, the rules shift to large-group underwriting.
QualifiesUnder the Affordable Care Act, Texas small-group plans are guaranteed-issue. That means a carrier must offer your business coverage and cannot charge more because an employee has a pre-existing condition, takes medication, or has been sick before.
The ACA also requires small-group plans to cover essential health benefits, including preventive care, maternity, mental health, prescription drugs, and emergency services. Your employees get comprehensive coverage from day one.
Most Texas carriers have two hurdles before they will write a small-group policy. You need enough employees to actually enroll, and you need to pay a minimum share of the premium. The exact numbers vary by carrier, but the ranges are predictable.
Most carriers require at least 50 to 75 percent of eligible employees to enroll in the plan. If too many opt out, the carrier may decline to issue the policy. We help you gauge enrollment before you apply.
Most Texas carriers require the employer to pay at least 50 percent of the employee-only premium. Some ask for more. You can choose to pay a higher share, but you usually cannot pay less and still qualify.
The participation and contribution rules apply to the employee-only tier. Dependents and family coverage are optional, and the employee typically pays the full difference for those tiers.
If the business is just the owner on payroll, most Texas carriers will still write a small-group policy. The owner counts as the employee and the employer, so they must meet both participation and contribution minimums themselves.
Small-group eligibility rules are straightforward. Full-time employees working 30 or more hours per week are eligible. Part-time employees may qualify if they work enough hours, depending on the carrier. Owners and officers on payroll are eligible too.
Spouses, domestic partners, and dependent children can usually be added at the employee's expense. Some plans extend coverage to adult children up to age 26.
A waiting period is the time between when an employee becomes eligible and when their coverage actually starts. Texas carriers typically allow waiting periods of 30, 60, or 90 days, and the ACA caps them at 90 days maximum. You choose the length when you set up the plan.
The most employee-friendly option. New hires get coverage quickly, which helps recruitment and reduces turnover during the first month on the job.
Fastest coverageA middle-ground choice. Gives you time to confirm the hire is working out while still getting them covered well before the ACA maximum.
BalancedThe longest allowed under the ACA. Some employers use this to reduce short-term turnover costs, though it can make hiring harder in a competitive market.
ACA maximumSee what you qualify for, what it costs, and which carrier fits your team.