Frequently Asked Questions

Disability insurance provides income replacement and financial security for employees if they become unable to work due to illness or injury, helping them focus on recovery and potentially return to work sooner. It also enhances your company’s attractiveness to potential employees.

Short-term disability covers a limited benefit period after a policy-defined waiting period. Long-term disability may pay for a set number of years or to a specified age, not automatically until retirement. Compare elimination periods, benefit periods, disability definitions and exclusions in the actual policies.

Compare the elimination period, income-replacement percentage, monthly maximum, benefit period and definition of disability. Review exclusions, pre-existing-condition limits, offsets for other income and how premium funding affects benefit taxation. Ask for a side-by-side comparison before selecting a policy.

Under an employer-choice model, the employer selects the available benefit design. Employee-choice arrangements let employees select among the options the employer and carrier make available. Compare contribution rules, enrollment requirements and any evidence-of-insurability requirements before offering choices.

Primary Care Insurance Solutions (PCIS) can compare short-term and long-term proposals using your employee census, budget and existing sick-leave benefits. Review waiting periods, benefit limits, exclusions and enrollment requirements together so the coverage fits your workforce. Request a policy comparison.

Group dental coverage can help employees budget for covered preventive and restorative care and strengthen a benefits package. Its value depends on participating dentists, annual maximums, waiting periods and employee costs; it does not guarantee better productivity or retention. Compare benefits employees can actually use.

Dental options may include PPO plans with network and out-of-network benefits, managed-care plans with designated participating dentists, and indemnity arrangements. Compare actual networks, reimbursement rules, deductibles, annual maximums and waiting periods rather than assuming one plan type is always cheaper.

Important factors to consider include whether employees can choose their own dentists, who controls treatment decisions, what services are covered, whether specialists are included, and how out-of-town emergency care is handled.

Primary Care Insurance Solutions (PCIS) can compare dental proposals using your employee census, contribution budget and preferred dentists. Review preventive, basic and major services, annual maximums, waiting periods and enrollment rules before choosing. Ask for a comparison that separates employer and employee costs.

Prepare an employee census, current plan or renewal, desired effective date and employer contribution budget. Identify important dentists and coverage priorities, then compare proposals on the same assumptions. Contact Primary Care Insurance Solutions (PCIS) to review options and plan the enrollment schedule.

An employer is generally an Applicable Large Employer (ALE) when it averaged at least 50 full-time employees, including full-time equivalents, during the prior calendar year. Related-employer and seasonal-worker rules can affect the calculation. ALE status determines whether the ACA employer shared-responsibility rules apply; it is not the same as Texas small-group insurance eligibility. Source: IRS, Determining if an employer is an applicable large employer.

An Applicable Large Employer may owe an employer shared-responsibility payment if it fails to offer the required coverage, or if an offer is unaffordable or does not provide minimum value, and a full-time employee receives a Marketplace premium tax credit. Different payment rules apply to the different failures. Liability depends on the coverage month, workforce and applicable year; confirm the calculation with legal or tax counsel. Source: IRS, Employer shared responsibility provisions.

Non-grandfathered individual and fully insured small-group policies generally must cover the ten essential-health-benefit categories, subject to applicable transitional relief. Large-group and self-funded plans do not have the same blanket requirement to cover all ten categories, although other ACA protections can apply. Confirm the market, funding arrangement and plan status before judging compliance. Source: Texas Department of Insurance, Small employer health insurance guide.

Start with the employer’s ALE calculation, the plan’s market and funding arrangement, and any grandfathered or transitional status. Then review applicable benefit protections, affordability, minimum value, eligibility, notices and reporting rather than treating essential health benefits or actuarial value as a universal compliance test. Primary Care Insurance Solutions (PCIS) can help organize the review; legal or tax counsel should confirm specific obligations. Sources: IRS, Employer shared responsibility provisions; Texas Department of Insurance, Small employer health insurance guide.

An employer averaging fewer than 50 full-time employees, including full-time equivalents, during the prior calendar year generally is not an ALE, subject to related-employer and other applicable counting rules. That does not remove all plan obligations. ACA small-group rating rules generally apply to non-grandfathered fully insured small-group policies, not every arrangement offered by an employer below 50. Self-funded and level-funded arrangements have different rules. Sources: IRS, Determining if an employer is an applicable large employer; Texas Department of Insurance, Small employer health insurance guide.

Yes. PCI Solutions serves Greater Greenspoint, Houston employers from our Houston office at 5920 Star Lane, Houston, TX 77057, not a local branch. Call 713-329-6944 to discuss your workforce, budget, providers and enrollment. We can help compare options and review enrollment changes and renewal; coverage and claims decisions remain with the insurer.

Texas small-employer coverage generally applies to businesses with 2–50 employees, subject to insurer eligibility. Confirm contributions and participation with the carrier. See our small-business health insurance guide; ACA employer obligations use a different full-time-equivalent calculation, explained in our ACA employer requirements guide.

Prepare a current employee census, contribution budget, desired start date, renewal documents and requested providers. A workforce-specific quote is needed; a nearby hospital does not establish a price or network. See our group health insurance cost guide for the comparison steps.

Record the campus, not just the system. Methodist lists Willowbrook at 18220 State Hwy. 249, Houston, and its Texas Medical Center hospital at 6565 Fannin St., Houston. These are location examples, not nearest-care or network claims. Check the locations employees request in the exact proposed network.

No. Houston identifies Greater Greenspoint as Super Neighborhood 2. Use the real street address the insurer requires, rather than treating the neighborhood as a municipality. Collect actual employee home and provider locations instead of assuming a Greenspoint work address describes their care needs.