A Comprehensive Guide on Why to Get a Second Opinion on Group Health Insurance in Houston

group health insurance in Houston

Group health insurance in Houston comes with an array of options. Is your small business maximizing your plan? 

Whether you’re searching for the cheapest health insurance in Texas or want to ensure your employees are fully covered, getting a second opinion about your plan is critical. 

Don’t overpay for health insurance.  

Join us in exploring the metrics influencing what you pay for group health insurance, particularly those associated with HRAs and SHOP plans.  

Why You Should Get a Second Opinion on Your Group Health Insurance Plan in Houston

To Reveal Your Health Insurance Group’s Key Metrics 

The basis for all business is metrics. However, group health insurance metrics may be a mystery for small businesses.  

Ensure your group health insurance plan is successful by closely examining these critical metrics. 

Average Claims Per Member

The average claims per member helps assess employee usage patterns. Higher claims rates indicate health issues across your workforce. Calculate the average number of claims filed per member by dividing the total number of claims by the total number of plan members.  

Loss Ratio 

Your loss ratio is a measure of the efficiency of your plan. Evaluating the profitability and sustainability of your insurance policies is determined by your loss ratio. A loss ratio below 100% will keep your premiums more stable. On the other hand, a loss ratio above 100% suggests the plan is paying out more than it is collecting, which will increase premiums for the group.  

Insurer/Broker Response Time  

Whether you use a broker or directly communicate with the insurer, response time is another critical metric. How quickly they respond to your claims submissions, inquiries, or employee issues can lead to a  happy or unhappy team.  

Track and analyze response times to get the most out of your insurer. You can compare these response times against industry standards to identify areas for improvement. The faster the response time, the more satisfied your team will be.  

Participation Ratio  

A higher participation rate ensures a broader risk pool, more stable premium rates, and better cost-sharing for the health insurance plan. Analyze participation rates within your plan over the years to spot trends. Any sudden drop or lower rates could indicate issues with plan communication or value.  

Communication, too, should be assessed. Communication strategies to discuss the benefits of health insurance plans ensure your group health insurance plan is used effectively by your team.  

Additionally, analyzing the plan features is also essential. As the years tick by, your employee’s needs change. The features that worked the previous year may no longer do so. If participation is low, it could be because your plan coverage is inadequate.  


Does your plan have a high dependency ratio? Keeping up with the number of dependents on your group plan can help you adjust your plan to fit your group better. Employers can also leverage this data to reassess your plan’s effectiveness and negotiate with insurers.  

Ultimately, the more customized your plan is for your group members, the better the plan, the lower the premiums, and the more satisfied you’ll be.  

To Determine What The Cheapest Health Insurance in Texas is For Your Group

Another important reason you should get a second opinion on your group health insurance plan is to get the cheapest health insurance possible. Every business wants to save money, and a deep dive into your policy helps you better understand what you’re paying for and why. 

Let’s look at two of the most common group health insurance policies in Houston for businesses: HRAs and Qualified Small Group Plans. We’ll look at plans provided through the Small Business Health Options Program and HRAs for small and large businesses.  

HRAs vs Group Health Insurance Plans—Which Is Right For You?

A Health Reimbursement Arrangement (HRA) is a tax-advantaged benefit account that employers can use to support employees in paying for qualified medical expenses. They are employer-funded and reduce the out-of-pocket medical costs, such as deductibles, for employees. 

Traditional group coverage, like that offered through the Small Business Health Options Program (SHOP), works differently. 

HRAs for Small Employers 

HRAs for small employers, also known as QSEHRA, help individuals cover their expenses tax-free. 


Employers can choose how much they contribute to employees up to the allowed annual limit for individuals and households. Each year, this number changes to accommodate inflation.  

Who Is Eligible?  

Small employers with fewer than 50 employees who don’t offer group health plan coverage qualify for  HRAs. 

What Type of Coverage Is Included?  

Employees may select how they use a QSEHRA so long as it is used for qualifying health care expenses when coupled with a plan from the Individual Marketplace.  

What Are The Enrollment Options? 

Employers can offer a QSEHRA any time of the year but must provide written notice to their employees  90 days in advance. Employees who get access to an existing QSEHRA will be eligible for a Special  Enrollment Period to enroll in coverage.  

What Contribution is Required?  

You get to decide as a small business what you’ll contribute to your employee’s health care costs, up to the annual maximum.  

What About Tax Requirements?  

QSEHRA reimbursements aren’t taxed to the employee. The employee won’t be allowed a premium tax credit for Marketplace coverage if the HRA is affordable. Should the opposite be true, the employee must reduce the amount of the advance payment of the premium tax credit (APTC). 

Qualified Small Group Plans, Including SHOP

Now, let’s take a look at qualified small-group plans. 


Qualifying small group plans allows employers to provide a plan and even offer a selection of plans for employees and, if they choose, for their employees’ dependents.  

Eligible Businesses  

Small employers with 1-50 employees could be eligible for SHOP coverage.  

Coverage Options  

Employees have a plan or selection that provides minimum essential coverage based on the employer’s offer.  

Enrollment Options 

For the most part, small businesses can enroll any time of the year for SHOP plans.

Employer Contribution Requirements 

To qualify for the Small Business Health Care Tax Credit, you’ll need to contribute at least 50% of the cost of premiums for all full-time employees enrolled in SHOP coverage. There is no contribution requirement for SHOP coverage.  


Group health plan contributions are not typically taxed to the employee. If you offer SHOP coverage and qualify, you could be eligible for the Small Business Health Care Tax Credit.  

Summarize Your Options: Get A Second Opinion 

Small businesses have options when it comes to employee healthcare coverage. HRAs offer customization, cost control options, and tax advantages but have limited plan options. 

On the other hand, the Small Business Health Options Program (SHOP) Plan provides employees with coverage options and employer contributions, making plans more affordable, but employee choice and simplicity can be costly.  

To make the best decision for your company, you need expert help. 

As group health insurance brokers in Houston, we provide informed guidance for our clients. Request a quote if you want to save money and ensure your coverage is appropriate. We’ll happily guide you to the right option.  

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