Frequently Asked Questions

Headcount changes may affect per-employee charges, minimum fees, participation requirements and benefit eligibility. Check when changes must be reported, how payroll-based charges are recalculated and whether minimum commitments apply. Ask for written examples of both growth and reductions before signing the contract.

The renewal summary from your current carrier: rates, plan designs, and employee count. A PDF is best. A clear photo or scan is fine if that is what you have.

Your current renewal next to other group health options, including a level-funded plan. Level funding is a fixed monthly payment that combines expected claims, stop-loss insurance, and plan administration. A surplus or a lower cost is possible with some contracts and is not promised.

Primary Care Insurance Solutions uses the summary to prepare the comparison. The file is stored where the public site cannot read it. It is not posted on this page.

Claims analysis is handled separately and securely with Dustin after the first conversation. Do not include claims or employee medical information in this upload.

Send the summary anyway and put the date on the form. If 48 hours is too tight for the decision, call 713-329-6944 and we will tell you what we can turn around.

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.

As of October 21, 2026, 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: https://www.tdi.texas.gov/pubs/consumer/cb040.html

As of October 21, 2026, 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: https://www.irs.gov/affordable-care-act/employers/employer-shared-responsibility-provisions

Verify each important doctor, facility and location against the exact plan network, not just the carrier name. Confirm with both the carrier and provider that they participate for the proposed effective date and are accepting patients. Keep the confirmation and recheck before enrollment.

Review the Summary of Benefits and Coverage for primary care, specialist and telehealth visits. Determine whether the deductible applies before copays or coinsurance and whether labs or procedures are billed separately. Compare in-network and out-of-network rules rather than relying on the office-visit copay alone.

Check the exact plan’s formulary for each medication, dosage and formulation. Review drug tiers, deductibles, copays or coinsurance, prior authorization, step therapy and quantity limits. Separately verify the pharmacy network and specialty-pharmacy requirements with the carrier before enrollment.

Compare the exact provider network, formulary, claims and appeal procedures, customer support and renewal terms. Review employer and employee costs together, including premiums, deductibles and out-of-pocket limits. Service extras such as wellness programs should not outweigh access to needed care and medications.

Worksite benefits are voluntary supplemental products offered through an employer, such as dental, vision, life and disability coverage. Employees often pay premiums through payroll deduction. These benefits supplement a benefits package; they are not a substitute for comprehensive major-medical insurance.