Frequently Asked Questions

Federal employer shared responsibility rules generally apply at 50 or more full-time employees, including full-time equivalents. Employers below that threshold generally are not required by federal law to offer coverage. Because part-time hours and related companies can affect the calculation, confirm your status before relying on a simple employee headcount.

Texas insurance law defines a small employer as a business with two to 50 employees, regardless of hours worked. Business owners may enroll if at least one employee also enrolls; owner-only businesses have different eligibility considerations. Carriers verify eligibility, participation and documentation. Primary Care Insurance Solutions (PCIS) primarily serves employers with ten or more employees; that service preference is not Texas’s legal minimum. This market definition is separate from the ACA ALE full-time-equivalent calculation. Source: Texas Department of Insurance, Small employer health insurance guide.

There is no single contribution percentage that fits every small-group quote. Carriers may require the employer to pay part of the employee premium, and their minimums can differ. Your contribution also affects employee participation and affordability. PCI compares the available rules against a contribution your business can sustain through renewal.

Potentially, depending on carrier availability, location, and group eligibility. HMO, PPO, and EPO labels describe different network and out-of-network rules. An HSA is an account, not a network; employees can contribute only when enrolled in an HSA-qualified high-deductible health plan and otherwise eligible under federal rules.

An eligible small employer can consider SHOP coverage, but current plan availability and carrier participation matter. SHOP may also be relevant to the small-business health care tax credit for qualifying employers. We compare SHOP, direct small-group, and other viable routes instead of assuming the marketplace is automatically the best or only choice.

None is best for every employer. Fully insured plans emphasize predictability, level-funded plans exchange a different risk structure for more claims visibility and possible savings, and an ICHRA gives employees individual-plan choice within an employer-set allowance. The right answer depends on workforce location, claims tolerance, administration, and budget.

Prepare an employee census, home ZIP codes, employment status, dependent coverage tiers, desired effective date, and current plan and renewal information if you have it. Also decide what the business can contribute and note important doctors, hospitals, and prescriptions. Complete census details should be sent only through the secure quote process.