This page contains a Flash digital edition of a book.
trending away from grandfathered plans. According to the survey, tma


.tips/KaiserSurvey, 37 percent of firms across all industries had at least one grandfathered plan option in 2014, down from 54 percent in 2013, 58 per- cent in 2012, and 72 percent in 2011. In the health care industry, 40


percent of firms of all sizes offered at least one grandfathered plan in 2014. Twenty-three percent of health care workers covered by workplace insur- ance enrolled in a grandfathered plan last year, the survey shows. The downside to grandfathered


plans is that carriers are not barred from raising rates due to the number, type, and amount of claims, and the group rate could spike if someone in the office is sick. Insurance programs that comply with ACA are not allowed to charge


more for preexisting conditions or for a higher frequency of claims. Ms. Rodriguez says just because


the plans she sells are ACA-compliant does not mean she’s getting them from the federal marketplace. In fact, she says, marketplace plans often come with higher deductibles and a smaller network of health care professionals to choose from. Big names in the industry like Aet-


na, United, Blue Cross and Blue Shield, and Humana all have ACA-compliant plans with lower deductibles that are not sold on the federal marketplace, she says. Ms. Rodriguez specializes in group


insurance for 50 or fewer employees. If you’re shopping around for a plan that better fits your practice’s needs, email her at krodriguez@tmait.org or visit www.tmait.org.


SHOP AROUND Physician-employers who choose to use the federal marketplace, either with help from TMAIT or on their own, can go to the Small Business Health Options Program (SHOP) Mar- ketplace, which is open to employers and nonprofit organizations with 50 or fewer full-time employees. (See “What to Look for When Shopping for Coverage,” page 61.) If a practice has fewer than 25 full-


time equivalent employees who make an average of $50,000 a year or less, it qualifies for a tax credit worth up to 50 percent of its contribution toward employees’ premium costs. Physician practices with fewer


than 10 employees who make an aver- age of $25,000 or less qualify for even bigger tax credits. To shop for small business cover-


WHAT PRACTICES OFFER EMPLOYEES, BY REGION


The Texas Medical Association Insurance Trust (TMAIT) services more than 232 group practices in four areas: West Texas, the Dallas area, the Houston area, and all other areas of the state. Those groups offer their employees these types of insurance:


Medical Insurance


West Texas 22 groups


Houston area 66 groups


Dallas area 69 groups


All other areas 75 groups


62 TEXAS MEDICINE March 2015 14 (64%) 47 (71%) 56 (81%) 64 (85%) Dental


Insurance 8 (36%)


31 (47%) 24 (35%) 40 (53%) Vision


Insurance 1 (5%)


6 (9%) 5 (7%) 7 (9%) Life


Insurance 14 (64%)


28 (42%) 18 (26%) 18 (24%)


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68