Insurance terminology can make an ordinary coverage question difficult to resolve. This collection explains concepts such as deductibles, claims, provider billing and the way different forms of health coverage interact. Houston and Texas employers can use these articles to prepare for employee questions and distinguish plan administration issues from medical decisions. Start with the topic you need to understand, then consult the relevant plan documents before making a coverage assumption or promising a particular payment.
69 articles
Compliance
The 2027 ACA affordability percentage is 10.22%. See what it means for your employee contributions, the three IRS safe harbors and 2027 penalty amounts.
Group Health Insurance
A level-funded health plan is a self-funded employer health plan packaged with regular monthly payments for expected claims, administration and stop-loss insurance. It can make budgeting easier, but it is not the same as buying fully insured coverage. The employer retains plan responsibilities and contract-dependent financial exposure.
Broker Strengths
Stop-loss insurance helps a self-funded employer manage unusually high eligible health claims by reimbursing amounts above policy attachment points. Specific coverage addresses one person’s claims; aggregate coverage addresses the group’s total eligible claims. Stop-loss protects the employer, not employees directly, and it does not eliminate exclusions, reimbursement delays or every financial responsibility.
Employee Benefits
A third-party administrator (TPA) performs contracted administrative work for a health plan, such as processing claims, maintaining eligibility and supporting members. A TPA is not automatically the insurer or the source of claim funding. In a self-funded arrangement, the employer generally funds covered claims while the TPA administers them under the plan's terms.
Group Health Insurance
A focused 2026 renewal update: revised HSA and affordability figures, group-specific rate changes, pharmacy review and funding comparisons.
Broker Strengths
Renewing the plan does not necessarily end the broker decision. Review service concerns, carrier requirements, and handoff steps before making a change.
Employee Benefits
Level funding is a form of self-funding. Compare packaged payments with traditional claims funding, using the actual contracts rather than savings promises.
Group Health Insurance
An evergreen employer guide to enrollment calendars, renewal decisions, employee contributions and clear benefits communication.
Group Health Insurance
Reconcile premiums, administration, stop-loss, pharmacy terms and broker compensation before signing or renewing a group health arrangement.
