How Practice Owners Can Control Health Insurance Costs During Open Enrollment


If you’re a practice owner shopping for health insurance during open enrollment, Nov. 1 to Dec. 15, there are ways to control the cost of your health insurance.

You might think increasing the deductible – the amount each employee must pay before the insurance company begins to pay benefits – is the way to offset a premium increase. However, it may be worth considering another way to manage costs so benefits can be maintained or made more affordable for your practice.

Controlling Direct Costs

The health insurance advisors at TMA Insurance Trust know of a lesser-known option that you can use to keep a group plan cost within budget. This entails taking advantage of special waivers to the criteria your practice needs to meet to qualify for group health insurance.

Usually, to qualify as a group, 75% of eligible uninsured employees need to participate, and the practice needs to contribute 50% of the premium for each participant. But during open enrollment, practices won’t need to meet those criteria to qualify for a group plan.

Waivers can be used to achieve various goals:

  • Getting group PPO coverage for yourself and your family – Most physicians want the flexibility of a PPO plan, but individual plans are not available in Texas. If you own a practice with a tax ID number and at least one employee (besides yourself), you may be able to qualify for a group PPO plan for yourself and your family. You would have to make the coverage available to employees as well, but you would not be required to contribute toward their premiums. 
  • Offering a group plan to employees – Practices with smaller budgets can use the waivers to offer group coverage to employees. So instead of everyone in a practice buying an individual insurance plan, the waivers make it possible to offer group coverage to employees. Participants typically can obtain better coverage at a lower cost than if they purchased coverage individually.

If you are establishing a new group health plan, or are interested in changing your group to a new insurance carrier, you may be able to utilize the Contribution Requirement Waiver. This would allow your practice to adjust the percentage they contribute toward the employee cost, which will help maintain better coverage for all participants.

 Controlling Indirect Costs

There is another cost that comes with a group health insurance plan: the time you and your staff spend administering the plan. This includes time spent enrolling the staff and their dependents; making sure participants receive temporary ID cards and coverage information; dealing with staff updates and changes during the year; and billing, customer service, and claim issues. That’s time away from treating patients and running the practice.

Working with an advisor, such as one of the professionals at the TMA Insurance Trust, can relieve you and/or your staff from much of the administrative burden associated with group plans.

To find out more about these limited-time waivers and group benefit options, contact a TMA Insurance Trust advisor at (800) 880-8181 from 7:30 am to 5:30 pm (CT) Monday through Friday, or visit the TMA website.


Last Updated On

November 22, 2019

Originally Published On

November 13, 2019

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