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She says insurance carriers pay


TMAIT a commission for each sale, but a portion of that money goes back into TMA to support the practice of medicine. “We’re here to support our physi-


cians,” she said. TMAIT services more than 200


groups in four areas: West Texas, the Dallas area, the Houston area, and all other areas of the state. (See “What Practices Offer Employees, By Region,” page 62.) ACA doesn’t require small-group


employers to contribute toward em- ployee premiums, but many insurance companies require employers to pay at least 50 percent of their employees’ plan premiums. Employers may choose to pay a


higher percentage than the company requires. Employers are not required to contribute toward the cost of de- pendent coverage. Ms. Rodriguez says most groups


she assists pay 100 percent of the em- ployee cost and leave it to their em- ployees to pay the premium for spous- es and dependents. Physicians may choose to offer


their employees a preferred provider organization (PPO), an HMO, a point- of-service (POS) plan, or a health sav- ings account (HSA). Ms. Rodriguez says PPOs are the most popular, as HMOs offer a smaller network of care at a comparable price. HSAs are less expensive for physicians, but employ- ees don’t often favor them because many services are subject to a deduct- ible, she says. Many physicians choose to offer


split plans, for example, a PPO/HSA, which gives employees the option to choose which plan they prefer. Ms. Rodriguez says some physi-


cians choose to stick with grandfa- thered insurance plans that are not compliant with the new law and are not required to contain the essential health benefits. The Kaiser Family Foundation’s


“2014 Employer Health Benefits Survey” shows that employers are


March 2015 TEXAS MEDICINE 61


WHAT TO LOOK FOR WHEN SHOPPING FOR COVERAGE


• Compare plans and rates. Plans with higher deductibles and copayments generally have lower premiums. Keep in mind that your employees then would have to pay more out of pocket to access services or benefits.


• Consider factors other than cost, such as a company’s financial strength and compliance record. You can find these by calling the Texas Department of Insurance (TDI) Consumer Help Line at (800) 252-3439 or (512) 463-5515 in Austin.


• Buy only from licensed insurance companies and HMOs. Selling unlicensed coverage is illegal in Texas. If you buy from an unlicensed company, your employees’ claims could go unpaid and you could be held liable for the full amount of your employees’ claims and losses. You can learn whether a company is licensed by calling the TDI Consumer Help Line.


• Understand that employee health coverage is different from workers’ compensation insurance, which covers only job-related injuries and illnesses. Providing regular health coverage to employees isn’t a legal alternative to providing workers’ compensation insurance.


Source: Texas Department of Insurance, www.tdi.texas.gov /pubs/consumer/cb040.html


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